Diagnosis Flashcards
1
Q
What can pain at night mean?
A
- malignancy
- fracture
- bursitis
- gout
2
Q
What symptoms indicate a meniscus injury?
A
- clicking, locking, catching
- valgus twisting
- painful in full extension
- McMurrays: painful click in joint line with extension
3
Q
Symptoms of a Benign Breast tumour?
A
- tender and movable
- ddx fibocystic breast disease
4
Q
Symptoms of a Malignant breast tumour?
A
- firm and non-movable
5
Q
Where is the most common spot for a malignant breast tumour?
A
- in the axilla
6
Q
Where is the most common location for a meniscus tear?
A
- posterior corner
7
Q
What is a brain aneurysm?
A
- traumatic or congenital rupture of middle or anterior cerebral arteries or communicating branches of circle of Willis
- if suspect send to hospital
8
Q
What are the areas a brain aneurysm is most likely to occurs from most common to least common in the circle of Willis?
A
- anterior communicating 35%
- internal carotid, posterior communicating and ophthalmic 30%
- middle cerebral 22%
9
Q
What tis the most common type of brain aneurysm?
A
Berry Aneurysm
10
Q
What is the most common cause of a subarachnoid hematoma?
A
- berry aneurysm
11
Q
Signs and Symptoms of a brain aneurysm?
A
- worst HA of life
- new/change to HA
- can compress the cranial nerves = ocular palsies, diplopia, facial pain
- Visual loss (bitemoral field defect suggesting optic chiasm pressure)
- vomiting, dizziness, change in pulse and respiration
- stiff neck
- +kernigs test (hip and knee flexed to 90 + if cause pain in neck/back)
- B/L babinski
12
Q
What Diagnostic tests help to confirm aneurysm?
A
CT scan shows blood
13
Q
Symptoms of Cranial Nerve Damage: 1 Olfactory?
A
- anosmia = loss of smell
14
Q
Symptoms of Cranial Nerve Damage: 2 Optic?
A
- Bilateral hemianopia = optic chiasma compression
- temporal hemianopsia
- nasal hemianopsia
15
Q
Symptoms of Cranial Nerve Damage: 3 Occulomotor?
A
- Diplopia, ptosis, dilated and fixed pupil
- Eye down and out b/c only abducens and trochlear work Superior oblique and lateral rectus
16
Q
Symptoms of Cranial Nerve Damage: 4 Trochlear?
A
- superior oblique does not work
- can not turn eye down and in
17
Q
Symptoms of Cranial Nerve Damage: 5 Trigeminal?
A
- loss of general sensation to face
- loss of corneal reflex
- loss of motor function of muscles of mastification
18
Q
Symptoms of Cranial Nerve Damage: 6 Abducens?
A
- lateral rectus does not work
- can not turn eye outward
19
Q
Symptoms of Cranial Nerve Damage: 7 facial?
A
- bell’s palsy (loss of muscles of facial expression)
- loss of anterior 2/3 of taste
- increase lacrimation
20
Q
Symptoms of Cranial Nerve Damage: 8 Vestibulocochlear?
A
- decreased hearing
- nystagmus
- vertigo
21
Q
Symptoms of Cranial Nerve Damage: 9 Glossopharyngeal?
A
- loss of posterior 1/3 of taste
- Loss of gag reflex (b/c pharynx)
- carotid sinus reflex
- dry mouth
22
Q
Symptoms of Cranial Nerve Damage: 10 vagus?
A
- Hoarseness
- dyspnea
- dysarthria
- dysphagia
- loss of gag reflex (palate)
- uvula deviates away from the side of the lesion
- visceral dysfunction
23
Q
Symptoms of Cranial Nerve Damage: 11 Spinal Accessory?
A
- paralysis of SCM = can not rotate head to opposite side
- shoulder drop
24
Q
Symptoms of Cranial Nerve Damage: 12 Hypoglossal?
A
- Hemiparalysis of tongue
- Tongue deviates toward side of lesion
25
What innervates the facets?
- medial branch nerve
26
What is Glaucoma?
- slow and progressive increase of fluid in eye
| - most common cause of blindness
27
What are the signs and symptoms of Glaucoma?
- no discharge
- blurred vision (loss of peripheral vision and slowly becomes more central)
- pain
- dilated and fixed pupil
- papilledema = optic disc swelling b/c increased intracranial pressure
- No pupillary light response
- increased intraocular pressure
- halo's around lights
28
What are the different types of Hematoma?
- Subarachnoid
- Subdural
- Epidural
- Intercerebral
29
What is a subarachnoid hematoma?
- a hemorrahage in the subarachnoid space caused by
1. berry aneurysm's in old people
2. A-V malformation in young people
30
What is a subdural hematoma?
- venous bleedings
- slow onset of symptoms after head injury
- takes hours-weeks for symptoms to come on
31
What is epidural hematoma?
- rupture of middle meningeal artery via fracture of temporal/parietal bones
- short lucid interval followed by rapidly developing
32
What is an intracerebral hematoma?
- is caused by hypertension
| - associated papilledema
33
What are the levels of adverse drugs reactions?
- Mild: no antidote
- Moderate: require change in drug
- Severe: life threatening
- Lethal: death
34
What are some factors that affect adverse reactions from drugs?
- drug type
- route
- duration of therapy
- dose
- bioavailability
35
What are signs and symptoms of substance abuse?
- withdrawal
- constant intake
- CAGE: cut down, annoyed, guilty, eye (when open eyes in the morning need to drink)
36
What is the causative agent of Bacterial Meningitis in neonates (meningococcal)?
E.coli
37
What is the causative agent of Bacterial Meningitis in children?
H. influenza
38
What is the causative agent of Bacterial Meningitis in Adults (pneumococcal)?
Strep Pneumoniae
39
What are the signs and symptoms of bacterial meningitis?
- HA
- fever
- stiff neck
- vomiting
- previous respiratory illness/sore throat
- seizure or cranial nerve neuropathies
- can cause Waterhouse-Friderichsen syndrome
- + Brudinski, kernigs, babinski
- CSF: cloudy, neutrophils, decreased glucose, increased protein
40
What is Waterhouse-Friderichsen syndrome?
- bilateral adrenal hemorrhage
41
What are the differences in the CSF b/w bacterial and viral meningitis?
- Bacterial: cloudy, neutrophils, decreased glucose, increase protein
- Viral: clear, normal glucose and proteins, increased lymphocytes
42
What is a VBI?
- a vertebrobasilar insufficiency which consist of brief neural abnormalities
43
What can cause a VBI?
- emboli from carotid or vertebral artery
44
What are the risk factors for VBI?
- high BP
- atherosclerosis
- heart disease
- atrial fibrillation
- diabetes mellitus
- polycythemia
- middle aged and elderly
45
What are the signs and symptoms of VBI?
- 2 to 30 min transient neuro deficits
- 5 D's and 3 N's
- Dizziness, Diplopia, Dysarthria, Dysphagia, drop attack, ataxia, numbness, nystagmus, nausea
- attacked should not last more than 24 hrs
46
What is the treatment of VBI?
- anticoagulants --> herparin, warfarin
| - refer to the MD
47
What is Wallenberg's syndrome?
- occlusion of Posterior inferior cerebellar artery
| - occurs because of an emboli
48
What are the symptoms of Wallenberg's syndrome?
- sudden onset of numbness or facial paralysis
- blurred or decreased vision
- dysarthria
- dysphagia
- HA
- neck stiffness
- loss of sensation or motor function on opposite side of body
49
What is Vertigo?
- hallucination of self or environment movement
| - feeling of spinning
50
What is Disequilibrium?
- My balance is off, i might fall
51
What is presyncope?
- I might pass out, I feel faint
52
What is lightheadedness?
- I just feel dizzy
53
What are differentials of vertigo?
vestibular disorder
- Benign Paroxysmal Positional Vertigo (BPPV)
- Otitis media
- Meniere's syndrome
- labyrinthitis
- acoustic neuroma
- salt - retaining vertigo
- brainstem dysfunction
54
What are differentials of Disequilibrium?
sensory/neuro dysfunction
- cervicogenic
- multiple sensory defects
- anxiety
- drug induced
- parkisonism
- alcoholic
- senile gait
55
What are differentials of presyncope?
decreased cerebral profusion
- orthostatic hypotension
- vasovagal
- unknown
- cardiac
- neurological
- situational
- psychogenic
- metabolic/drug
56
What are differentials of light-headedness?
anxiety/depression
- acute hyperventilation
- panic disorder
- hypoglycemia
- pheochromocytoma
- drug withdrawal
- epilepsy (temporal lobe)
- mitral valve prolapse
- cardiac arrhythmia
57
What are the symptoms of peripheral vertigo?
- sudden onset
- intermittent w/ severe symptoms
- affected by head position and movement
- severe nausea and vomiting
- motor function and coordination
58
What are the symptoms of central vertigo?
- gradual onset
- mild but constant
- unaffected by head position and movement
- nausea and vomiting less predictable
- loss of motor function, gait instability and loss of coordination frequency
59
What causes quick spins for a few seconds?
- BBPV
- vascular compression syndrome
- seizure
60
What causes dizzness for a few minutes?
- anxiety/panic disorder
- meniere's disease, migrane
- migraine variant
- TIA
61
What causes dizziness for hours to days?
- Migrane
- Meniere's
- infection: vestibular neuritis/labrynthitis
- stroke
- CNS lesions
62
What causes dizziness for days to weeks?
- Migraine
- Infection
- stroke
- CNS lesions
63
What is Labyrinthitis?
- inflammation of the bony or membranous inner ear
64
What cause's Labyrinthitis?
- bactera or virus
65
What are the signs and symptoms of labyrinthitis?
- vertigo for hours to weeks
- nystagmus
- ** no hearing loss
66
What are some complications that can occur with labyrinthitis?
- meningitis
| - facial nerve paralysis
67
What is Meniere's Disease?
- excessive endolymph in membranous labyrinth causing dilation
- also known as hydrops
68
What are the demographics of Meniere's disease?
- occurs more in men
| - from ages 20 - 50
69
What are the signs and symptoms of Meniere's disease?
- recurrent vertigo 20 mins to 2hrs
- sensory hearing loss, tinnitus
- fullness in ear
- nausea
- vomitting
usaully unilateral but can be bilateral
70
How to treat Meniere's disease?
- comanage w/ MD
| - SMT if makes it better cause is probably cervicogenic
71
What is an acoustic neuroma?
- tumor of CN 8 vestibular division
72
Signs and Symptoms of Acoustic neuroma?
- gradual hearing loss
- tinnitus
- dizziness
73
What is acute vestibular neuritis?
- sudden onset of vertigo
| - inflammation of CN 8 vestibular division
74
What causes acute vestibular neuritis?
viral infection in adolescents and young adults
75
Signs and Symps of Acute Vestibular Neuritis?
- Vertigo 7 to 10 days
- Nausea
- nystagmus toward the affected side
- no hearing loss or tinnitus
76
What is motion sickness?
- caused by a motion or visual person isn't adapted to
- excessive stimulation of vestibular apparatus by motion
- occurs only when 8th CN and cerebellar vestibular tracts are still intact
77
Signs and Symptoms of motion sickness?
- nausea
- vomiting
- sweating
- hyperventilation
- malaise
- salivation
- increased appetite
78
What are some complications of motion sickness?
- arterial hypotension
- dehydration
- depression
all occur w/ proloned vomiting
79
What is Multiple Sclerosis?
- progressive CNS disease w/ plaques of demyelination in the white matter of the brain and spinal cord and optic nerve
80
Demographics of Multiple Sclerosis?
- 20 - 40 year old women
81
S and S of Multiple sclerosis?
- remission and relapse periods
- paresthesia in 1 or more extremity, trunk or face
- weakness
- clumsiness
- visual disturbance: diplopia, decreased vision (scotoma, pain in one eye)
- Fatigue in limbs: gait disturbance
- vertigo
- bladder dysfunction
- emotional disturbance
- hyperreflexia
* diagnosis of exclusion
82
How to treat MS?
- corticosteroids (comanage MD, neurologist)
- rehab
- gait training
- ROM exercises
- physical activity
83
What is Myringitis?
- inflammation of tympanic membrane secondary to viral/bacterial infection
84
What causes Myringitis?
- S. Pneumoniae
85
SS of Myringitis?
- vesicles on tympanic membrane
- sudden ear pain
- hearing loss
- fever
86
Causes of Obstructed External Auditory canal?
- cerumen (wax)
- objects
- insects
- tumors:
ceruminoma: benign in outer 3rd
Basal Cell/squamous cell carcinoma- develop on pinna
87
What is Otitis Media?
- bacterial/viral infection of inner ear
88
Cause of Otitis Media?
- young children 3 months to 3 years
- Newborns: E. Coli, S
- Infants: S. Pneumoniae, H. influenza, S. pyogenes, S. aureus
- Children: S. Pneumoniae, S. aureus, S. pyogens
89
SS of Otitis media?
- 1st complaint is severe earache (pain)
- conductive/ sensorineural hearing loss
- fever
- nausea
- vomiting
- diarrhea
- tympanic membrane is red and bulging
- light reflex displaced
- bloody: b/c purulent otorrhea
90
Complications of Otitis Media?
- Meningitis
| - mastoiditis
91
Treatment of Otitis Media?
- antibiotics
92
Differentials of Otitis Media?
- chronic otitis media -> HX of tympanic membrane perforation, sensorineural hearing loss and no pain
- serous otitis media -> effusion in middle ear, conductive hearing loss
93
Where do temporal bone fractures most commonly occur and what is the risk?
- pterion
| - risk of middle meningeal artery rupture = epidural hematoma
94
Signs and symptoms of temporal bone fracture?
- impact
- CSF leakage or bleeding from ear
- Blue/black tympanic membrane
- sensorineural hearing loss or facial paralysis
95
Imaging to diagnose temporal bone fracture?
- CT scan
96
What is a temporal lobe seizure?
- complex partial seizure
| - looses contact with surrounding for 1 to 2 mins
97
SS of Temporal lobe seizures?
- stare
- purposeless movement
- unintelligable words
- hallucinations, vestibullar symps, spontaneous motor activity
- mental confusion for few minutes after the motors components stop
98
What is a Petit-mal (absent) seizure?
- 2 to 15 seconds of staring, longer = complrx partial
99
What is a Grand-mal (tonic-clonic) seizure?
- jerky rigid movement
| - lasts 2 to 5 mins
100
What is a Jacksonian seizure?
- abnormal primary cortex activity
- begins in hands and moves proximally
- sudden contraction
involuntary eye movement
101
What is a Hemothorax?
- collection of blood in the pleural cavity?
102
Cause of Hemothorax?
- ruptured aortic aneurysm, trauma
103
SS of Hemothorax?
- Dyspnea
- decreased chest expansion on side
- hyperresonance
- bronchial lung sounds
104
What is a Pneumothorax?
- collection of blood in the pleural cavity (b/w visceral and parietal pleura)
105
Types of pneumothorax?
- Traumatic:
open = penetrating chest wound causing lung collapse
closed = chest wall airtight thus air stays in the pleural space
- spontaneous:
no trauma, most commonly rupture of small apical bulla, tall young male, resolves itself if small
- tension
air enters lung but can't get out
106
SS of pneumothorax?
- dyspnea
- sharp chest pain
- dry cough
- mediastinal shift to opposite side
- decreased breathing sounds
- hyperresonance
- bronchial lung sounds
107
What is Atelectasis?
- lung collapse
| - most commonly b/c bronchial obstruction
108
SS of atelectasis?
- pain on affected side
- decreased lung expansion on affected side
- sudden dyspnea and cyanosis
- hypotension
- tachycardia
- increased temp
- decreased tactile fremitus
- dull percussion
- no breath sounds
- tracheal deviation towards side of collapse
109
Imaging for atelectasis?
- x-ray
110
What does x-ray of a collapse lung show?
- decreased lung size
- elevated diaphram
- deviated trachea/heart/mediastinum
- solid airless area within lung
111
Treatment for atelectasis?
- emerg
| - suctioning, bronchoscopy, respiratory therapy
112
What is bronchiectasis?
- local irreversible dilation of part of the bronchial tree
- involved bronchi are dilated, inflamed and collapse easy thus obstructing airflow and decreased clearance of secretion -> also because loss of ciila
- increased accumulation of secretions creates environment for infectious pathogen growth
113
Cause of Bronchiectasis?
- congenital = cystic fibrosis
- childhood infection
- inhalation of noxious chemicals
- vascular abnormalities
- immunogical reactions
- bronchiole obstruction (foreign body)
114
SS of Bronchiectasis?
- TRIAD:
- > persistent productive cough
- > copious purulent sputum
- > hemoptysis
- wheezing
- dyspnea
- crackles
- decreased breath sounds
115
What is acute bronchitits?
- inflammation of the tracheobronchial tree after upper respiratory tract infection (adenovirus, coronavirus)
- self limiting for 7 - 14 days
116
SS of Acute Bronchitis?
- Cough (dry non-productive that become productive)
- fever
- dyspnea
- rhonchi, crackling, wheezing
- tachypnea, tachycardia
- slight fever, malaise
- back and muscle pain
- night sweats, lethargy, anorexia
- nasal flaring
117
What is COPD?
- airflow obstruction due to chronic bronchitis or emphysema and airflow obstruction
- progressive and partially reversible
- consists of Chronic bronchitis and emphysema
118
What is chronic bronchitis?
- daily prodcutive cough for 3 consecutive months for 2 years
- progressive partially reversible
- BLUE BLOATERS = cyanotic b/c increase PCO2
119
What is Emphysema?
- Abnormal, permanent enlargement of air spaces distal to terminal bronchioles with destruction of their walls without fibrosis
- PINK PUFFER
- think barrel chest
- pursed lip breathing
- increased resp and HR
- tripod position leaning forwards with elboes on knees
- decreased tactile fremitus b/c hyperinflation
chest expansion decreased
- diaphram depressed
- hyper resonant
- breath sounds
120
SS of COPD?
- cough that's worse in the morning
- colorless sputum
- dyspnea
- wheezing
- cyanosis
- right heart failure
121
Complications of COPD?
- cor pulmonae )right sided heart failrue)
- acture respiratory failure
- pneumothorax
- arrhythmia
- pulmonary embolism
122
Treatment of COPD?
- educate on not smoking b/c
- > decrease bronchiole obstruction
- oxygen therapy
123
What is asthma?
- reversible airway obstruction
- inflammation and increase responsiveness to variable stimuli
- spasm of smooth muscle
- edema of airway mucosa
- increased mucus secretion
- cellular infiltration and desquamation of airway epithelium = bronchospasm
- onset in early childhood
- Type 1 hypersensitivity reaction IgE
124
SS of asthma?
- symptoms vary
- worse during night and early morning
- wheezing, dry coughing, dyspnea, chest tightness
- during attack: tachypnea, tachycardia, hyperinflated chest, cyanosis
- rhinitis
- family HX of ashtma
- increased eosinophils and lymphocytes
125
Treatment of asthma?
- med from MD commange
126
What is Congestive Heart Failure?
- inability of the heart to maintain adequate cardiac output to meet the demands of the body
- inability of heart to clear venous return resulting in vascular congestion
- fluid accum in lungs, abdominals and peripheral tissue
- # cause of coronary artery disease
- Left ventricle failure = decreased CO = increased pulmonary venous pressure
- right ventricular failure = increased systemic venous pressure (hepatomegaly, splenomegly, dilated veins
127
SS of Congestive heart failure?
- asymptomatic at first
- early symp: dyspnea with exertion and increased fatigue
later: orthopnea
128
SS of Left heart failure?
- fatigue, syncope, low BO, cool extremities, slow capilary refill, peripheral cyanosis, mitral regurgitation, Cheyne-stokes breathing
- Venous congestion causess: exertional dyspnea, orthopnea, basal crackles, cough, hemoptysis
129
SS of Right sided heart failure?
- low CO: dyspnea, tricuspid regurgitation
- peripheral edema
- hepatomegaly
- hepatic tenderness
increased jugular vein prominence
130
What is the cause and location of an Abdominal aortic aneurysm?
- L3 and L4
| - atherosclerosis/arteriosclerosis = most common casue
131
SS of Abdominal aortic aneurysm?
- deep boring visceral pain in low back
- abdominal pulsations and bruits
- TRIAD of rupture
- >hypotension
- >flank pain
- > palpable abdominal mass >3.8cm
- if mass <5cm monitor if mass greater than 5cm refer for surgery
132
Who is at risk for a thoracic aortic aneurysm?
- ehler;s danlos
- marfans
- trauma
133
SS of Thoracic aortic aneurysm?
- pain (spine and thoracic cage)
- cough, wheeze hemoptysis
- dysphagia
- horners syndrome:
- > miosis
- >anhydrosis
- >ipsilateral side
- tracheal deviation away from aneurysm
134
What is Angina Pectoris?
- myocardial ischemia
135
SS of angina pectoris?
- chest pressure < 30 min
- exertion, emotion, eating
- relieved by rest and nitroglycerin
- ST wave depression
136
What is a Myocardial infarction?
- ischemia with myocardial necrosis due to decreased coronary blood flow
137
SS of Myocardial Infarction?
- Prodrome: 2-3 weeks before MI get angina fatigue
SOB
- deep substernal chest pain, radiation to the chest, left arm and jaw
- greater than 30 mins of pain not relieved by rest nitro
- ST wave elevation
- associated symptoms, dizziness, nausea, pallor, diaphoresis, anxiety, fatigue, dyspnea, impending sense of doom
138
What do Diagnostic tests show for Myocardial Infarction?
- increased troponin I and T, ST wave elevation
139
What is Costochondritis?
- localized pain and tenderness at costochondral junctions
140
SS of Costochondritis?
- insidious sharp, pressure onset chest wall pain
- HX minor trauma or activity
- *** young male chest pain after working out
- increased pain with deep inspiration, exertion
- no edema/inflammation
141
What is Tietze syndrome?
- unilateral inflammation/edema of one or more costochondral junction
- most common in women > 50
- type of costochondritis
142
What is GERD?
- most common motor disorder of the esophagus and results from decreased lower esophageal spincter pressure allowing reflux to occur
143
SS of GERD?
- Heartburn, Regurgitation, retrosternal burning
- dysphagia
- chest pain, radiates into back, neck and arms (similar to MI)
- Hoarseness
- chronic, non-productive, irritating cough
144
What aggravates GERD?
- large meals, bending forward, lying down
145
What Relieves GERD?
- Antacids, coating agents, burping
146
What causes ulcers?
- NSAIDs
| - H. pylori
147
What aggravates a Duodenal ulcer?
- is too much acid secretion
- increased pain at night (when not eating)
- epigastric pain, burning gnawing or hunger
- usually 40
148
What relieves pain from a duodenal ulcer?
- food relieves the pain = weight gain but pain reoccurs 2-4 hrs after eating
149
What aggravates gastric ulcer?
- hypo acid secretion
| - food increases the pain = weight loss
150
What is a hiatus hernia?
- protrusion of stomach above the diaphragm
- sliding = gastroesophageal junction above diaphragm
- paraesophageal = only a portion of the stomach above the diaphragm
151
SS of hiatus hernia?
- asymptomatic
- increased chest pain
- heart burn, regurgitation with bending forward
152
Complications of a hiatus hernia?
- stragulation, adenocarcinoma
153
What is a pancoast Tumor?
- tumor within the superior pulmonary sulcus
154
What is pancosst syndrome?
- pain in the shoulder, vertebral border of the scapula and ulnar distribution of arm/hand (thoracic outles
- Horner syndrome also occurs:
- > ptosis
- > miosis
- > anhydrosis
- absent triceps reflex
- paraneoplastic syndrome
155
What does an xray of a pancoast tumor show?
- pleural thickening in the apex of the lung
156
What causes pleuritis?
- entry of infectious agent, irritating substance or neoplastic cells into pleural space
- trauma or pleural disease can also cause problems
157
SS of pleuritis?
- Hx of chest cold
- inflammation of pleural
- exudate b/c of pleural effusion
- stabbing chest pain, increases w/ cough, breathing and flexion
- rapid shallow respiration
- decreased breathe sounds and friction rub
- decreased chest expansion on affected side`
158
What is pneumonia?
- inflammation and consolidation of lung tissue like the parenchyma, alveolar spaces and interstitial tissue
159
What does S. pneumoniae (pneumococcus) cause?
- This is the typical cause of Lobar pneumoniae (consolidation)
- also causes the Quellung reaction -> also called the Neufeld reaction, is a biochemical reaction in which antibodies bind to the bacterial capsule
160
What is the atypical cause of pneumonia?
- Mycoplasma
- in ages 5 to 35
- like the flu
- patchy consolidation
161
What are the stages of Lobar pneumonia (s. pneumoniae)?
- consolidation
- red hepatisation
- resolution (CRGR)
162
What are other causes of pneumonia?
- staph aureus
| this affects mostly the eldery and is patchy consolidation like the pneumonia caused by myoplasma
163
SS of Lobar pneumonia (S. pneumoniae)?
- rusty sputum
- productive cough
- HA, fever, chills
- pleurisy (chest pain with coughing)
- crackles, bronchial breathe sounds = signs of consolidation
164
Sputum color of mycoplasma pneumonia?
- green
165
Sputum color of klebsiella?
- currant jelly
166
What is the most common cause of AIDS?
- pneumocystitis carinii
167
Cause of Pulmonary embolism?
- DVT
- fat embolism after fracture
- air when diving
- pregnancy
168
SS of pulmonary embolism?
- Tender and swollen sinuses
- nasal mucosa red and turgescent
- yellow or green rhinorrhea
- maxillary, ethmoid, frontal sinusitis causes local pain and frontal HA
- malaise
- fever and chills b/c infection
169
What ribs are most likely to fracture?
- ribs 4 -10
| - posterolateral convexity
170
SS of rib fracture?
- pain with inspiration or deep breathing, coughing or lying on the same side as fracture
- pain or crepitus at localized point over rib
- if rib fracture from 8 - 12 occurs their can be organ damage
171
What will xray show in a rib fracture?
- fracture line
- cortical offset
- callus formation (occurs within 10 to 14 days)
172
SS of rib subluxation?
- sharp, stabbing, burning and or aching pain along the rib
- paraspinal hypertonicity
- tenderness over TVP or angle of the rib
- sternal/thoracic compression and loss of end feel compliance
173
What aggravated a rib subluxation?
- rotation
- lateral bending
- reaching or carrying loads on shoulder, deep breathing
174
What causes shingles?
- Herpes varicella zoster
| - latent chicken pox in the posterior root ganglion
175
SS of shingles 2 to 3 days before shingles appear?
- 2 to 3 days before rashes appear
- > pain, tingling or burning in involved dermatome
- > fatigue, malaise, HA, low-grade fever
176
SS of shingles?
- localized pain
- erythema (red skin with swollen feeling
- vesicles (in one or more dermatomes) a couple of days after onset of pain
- itching and burning but does not cross the midline
- vesicles are dense, same blisters that are easily broken and ooze
- lesions will turn into a brown/black pustule/crust which scabs and falls off within a couple of weeks
- fever HA, lymphadenopathy
177
How long do shingles take to recover?
- 2 to 3 weeks in children and young adults
- 3 to 4 weeks in older patients
- pain can last greater than a month this is called post hepatic neuralgia
178
What are red flags of shingles?
- CN 5 involvement b/c eye lesions can lead to blindness
| - facial nerve involvement = facial paralysis, loss of taste in anterior 2/3 tongue called ramsey hunt syndrome
179
Cause of sternal fracture?
- motor vehicle accident
180
SS of sternal fracture?
- local pain over sternum
- ecchymosis
- dyspnea or pain on inspiration or deep breathing
- palpable defect or crepitus
181
Cause of sternoclavicular joint dislocation?
- FOOSH injury
| - anterior dislocation is most common
182
SS of SC joint dislocation?
- pain with arm motion
- pain with compression against affect shoulder
- medial clavicle protrusion
- anterior/inferior displacement of shoulder
183
Risks of SCJ dislocation?
- posterior dislocation can compress the trachea, subclavian vessels or brachial plexus
184
What is endocarditis?
- inflammatory process of structures in heart caused by infective organisms
185
Causes of subacute endocarditis?
- infection from dental work
- bacteria part of normal flora ex. e. coli amd s. aureus
- the bacteria enters the pre-existing lesions or defective structures ex. defective heart valves or septa. rheumatic fever, syphilis
186
SS of subacute Endocarditis?
- Heart murmur
- fever chills
- general weakness, embolism (causes neuro deficits), enlarged spleen
- petechiae in conjunctiva, head, neck and upper thorax
- fatal if not treated within weeks
187
Cause of Acute endocarditis?
- staph aureus
- strep pneumoniae
- N. gonorrhea
- mostly affects heart valves that are normal and abnormal
188
SS of Acute endocarditis?
- absence of heart murmur
- high fever, rigors, sweating, leukocytosis
- fatal within a few days or weeks if untreated
189
What is primary dysmenorrhea?
- cyclic pain associate with ovulatory cycle; begins in adolescence and decreases with ages
190
What is secondary dysmenorrhea?
- endometriosis = benign endometrial tissue growth grows outside uterine cavity
- PID, leiomyoma, IUD
191
SS of Dysmonorrhea?
- lower abdominal cramping
- dull constant pain in low back, begins with menses
- HA, nausea, constipation, disrrhea
192
What does lytic mets cause?
- increase in serum Ca+
193
What does blastic mets cause?
- increased serum ALP
194
Define obesity?
- > 30% more than ideal weight`
195
What is BMI
- weight/height
- <18.45 is underweight
- 18.5 to 24.9 normal
- 25 - 29.9 overweight
- 30 - 39.9 obese
- >40 morbidly obese
196
What is prostatitis?
- inflammation or infection of the prostate
197
SS of prostatitis?
- UTI
- urinary frequency/urgency, dysurea
- LBP or perineal
- chills, fever
- urethral discharge
- enlarged, boggy, tender prostate
- leukocytosis
198
Causes of urinary tract infection?
- e.coli
199
Cause of urethritis?
- Gonorrhea
| - Chlamydia
200
SS of urethritis?
- gradual onset
- purulent discharge
- dysuria, pyruia, frequency
201
Cause of Cystitis?
- E. coli
202
SS of Cystitis?
- sudden onset
- Frequency, urgency, burning, painful voiding
- no discharge
- suprapubic pain
203
SS of Pyelonephritis?
- rapid onset
- chills, fever, flank pain, nausea, vomiting
- costovertebral tenderness
204
What are the types of Claudication?
- Neurogenic
| - vascular
205
SS of neurogenic claudication?
- pain with walking and standing
- relieved by flexion
- normal pulses
206
SS of vascular claudication?
- pain with walking
- relieved with rest and standing
- not relieved with flexion
- decreased pulses and skin changes
207
What creates myelin sheath in the CNS?
- oligodendrocytes
208
What creates myelin sheath in the PNS?
- schwann cells
209
What is myopia?
- nearsighted
| - can see objects which are close well but objects which are far are blurry
210
What is hyperopia?
- farsighted
| - can see objects far away but not close
211
What is encephalitis?
- swelling of the brain
212
Cause of encephalitis?
- viral:
- arbovirus
- polio
- echo
- herpes
- varicella
- mumps
213
SS of encephalitis?
- fever, malaise
- meningeal signs
- HA, vomiting, stiff neck and back
- altered consciousness, personality change, seizure, CN abnormalities
214
SS of joint fixation?
- pain with active movemnt
- relief with rest
- achy, dull pain
- decreased ROM
- compression of the joint reduces pain
215
What is lateral epicondylitis?
- partial/full tear of the extensor carpi radialis brevis
216
Cause of lateral epicondylitis?
- repetitive motion: wrist extension, radial deviation, supination
217
SS of lateral epicondylitis?
- gradual intermittent elbow pain
- weakness on grasping
- cozens -> resisted wrist extension w/ elbow flexion and mills -> extension of elbow, wrist extension and ulnar deviation positive
218
What is medial epicondylitis?
- common flexor tendon pain
219
Cause of medial epicondylitis?
- overuse
220
SS of medial epicondylitis?
- gradual onset of medial elbow pain
- pain with activity and relieved with rest
- pain with active/passive elbow flexion and pronation
221
Where does median nerve (C5 - T1 lateral cord) entrapment occur?
- axilla
- bicipital aponeurosis
- intercondylar ridge
- ligament of struthers
- pronator teres
- flexor digitorum
- superficialis
- carpal tunnel
222
SS of Pronator teres syndrome?
- anterior forearm pain
- Hx of repetitive pronation and wrist flexion
- pain with resisted pronation with elbow extended
223
SS of bicipital median nerve compression?
- pain with resisted supination with elbow flexion
224
SS of Flexor digitorum superficialis median nerve compression?
- pain with resisted middle finger flexion
225
SS of anterior interosseous syndrome (median nerve compression)?
- motor branch of the median nerve: innervated flexor pollicus longus, flexor digitorum profundus and pronator quadratus
- cannot perform the okay sign with the tips of their fingers
226
SS of carpal tunnel?
- prolonged extension, pregnancy, RA, vitamin B deficiency
| - pain numbness and tingling in the palmar thumb and the 3 radial fingers
227
What is ape hand?
- cannot oppose/ abduct hand
228
Where does radial nerve ( C5 - T1) entrapment occur?
- axilla
- spinal groove
- arcade of froshe
- supinator
- brachioradialis
229
SS of posterior interosseous nerve syndome?
- superficial branch of radial nerve compressed
- lacinating pain into the back of the forearm and hand
- weak wrist, thumb or index finger extension
- no sensory loss
230
Test for Radial Nerve entrapment?
- resisted middle finger extension test
- resisted thumb extension (extensor policis longus)
- wrist drop also occurs
231
Where does the ulnar nerve (C8 - T1 medial cord) entrapment occur?
- axilla
- flexor carpi ulnaris
- cubital tunnel
- guyons canal
232
SS of ulnar nerve entrapment?
- claw hand 4 - 5th PIP/DIP flexion
- less of thumb adduction
- loss of abduction/adduction in the finger
233
What is a Baker's Cyst (popliteal cyst)?
- fluid dissension of gastoc-semimebranosis bursa
234
Cause of baker's cyst?
- osteo arthritis
| - charcot joint
235
SS of backer's cyst?
- posterior knee pain
- decreased flexion
- difficulty straightening after seated
- popliteal mass
236
What is chondromalacia patella?
- softening, erosion, fragmentation or scarring of articular surface patella
- gradual intermittent pain
- most common with quad contraction + clarkes test
- increased pain with sit to stand test and going downstairs
- crepitus
- night pain
- movie-goers sign
- tendon to patella ratio > 20%
237
SS of fibular head fixation?
- sudden dorsiflexion or plantarflexion = pain
- sudden onset of lateral knee pain
- increased pain with hamstring curls
- may irritate the common peroneal nerve
238
What is De'Quervians Syndrome?
- tenosynovitis of abductor pollicus longus and extensor pollicus brevis
239
Cause of De'Quervians syndrome?
- Hx of forceful gripping with ulnar deviation or repetitive use of thumb
- local pain over anatomical snuff box tendons, pain into forearm and swelling @ wartenberg's point
- positive finkelsteins
240
What is a lumbosacral strain?sprain?
- damge to ligament or muscle in the lumbosacral region
241
What is a grade 1 lumbosacral strain?
- 1 - 10% damage to fibres
- minimal pain
- trigger points
- decreased ROM
- heals in 1 to 4 weeks
242
What is a grade 2 lumbosacral sprain/strain?
- 11 to 50% damage to the fibers
- hemorrhage and minimal swelling
- moderate pain
- muscle splinting
- decreased ROM
- heals in 2 weeks to a year
243
What is a grade 3 sprain/strain?
- greater than 50% damaged fibers
- ecchymosis, swelling
- complete loss of ROM
- no pain with complete ligament tear
- palpable deformity
- heal in 2 months to a year
244
Cause of the avulsion fracture of the ASIS?
- sartorius muscles pulls off a piece of the ASIS in a young athele
245
SS of an avulsion fracture of the ASIS?
- sudden onset of acute pain w/ local swelling
- POP sound
- increased pain with hip and trunk movement especially in abduction and flexion
246
SS of bursitis?
- pain in all AROM
- swollen and hot
- pain with isometric testing
- night pain
247
Cause of Olecranon bursitis?
- gout
| - increased weight bearing on elbows
248
SS of olecranon bursitis?
- distal olecranon swelling
- local pain and tenderness
- increased pain at max extension or flexion
- increased pain with resisted tricep extension
249
Location of pes anserine bursitis?
- sartorius muscle
- grailis muscle
- semitendinosis muscle
- inserts superficial to the MCL
250
SS of pes anserine bursitis?
- pin-point pain at bursa
- increased pain with a run (worse at the end of a workout)
- pain with stretching hamstrings, resisted knee flexion
- warmth and tenderness at inferomedial knee
251
SS of subacromial bursitis?
- associated with preceding tendonitis or tenosynovitis
- excruciating pain without relief with repositioning
- all active movement is painful
- pain an limitation on passive abduction as this compresses the bursa
- empty end feel
- heat and swelling
252
Most common location of plica syndrome?
- mediopatellar
253
SS of plica syndrome?
- clicking, high pitched snapping, giving way and catching of the knee
- aggravated by activity, prolonged standing/sitting/squatting
- taut band reproduced pain on palpation
254
Cause of posterior hip dislocation?
- MVA
- occurs in the posterior 70 - 80%
- mechanism of injury: hip flexed, adducted and internally rotated
255
Cause of anterior hip dislocation?
- MVA
| - mechanism of injury: hip flexed, abducted and externally rotated
256
SS hip dislocation?
- severe pain in the hip and upper leg
- inability to weight bear
- posterior- affected limb is shortened, internally rotated and adducted
257
Cause of ITB syndrome?
- overuse with running, running downhill or any flexion at 30 - 40 degrees
258
SS of ITB syndrome?
- gradual onset of pain
- pain with running especially running downhill
- noble's compression test pain at distal ITB @ >30 degrees when extending knee and hip from a flexed position while applying pressure to the outer aspect of the leg or greater
- obers test positive
259
What is an inguinal hernia?
- a portion of the intestines are forced through a weak spot in the inguinal canal
- occurs mostly in people above the age of 40
260
What is a direct hernia?
- weakness in the floor of the inguinal canal
| - mostly in people above the age of 40
261
What is a indirect hernia?
- passes through internal inguinal ring = most common
262
SS of inguinal hernia?
- lump or pain in the groin
| - partial or complete blockage of the intestines this increases the risk of strangulation
263
What is juvenile rheumatoid arthritis?
- an autoimmune disorder
- begins before the age of 16**
- greater than one joint must be affected for greater than 6 months
264
What are the types of juvenile rheumatoid arthritis?
- Still's disease
- Pauciarticular
- Polyarticular
265
SS of Still's Disease?
- systemic onset
- one joint affected
- high fever, rash, splenomegaly
- RF and ANA (antinuclear antibodies) absent
266
SS of pauciarticular juvenile rheumatoid arthritis?
- less than 4 joints
- young girls (1 to 5)
- large joints, eye changes
- ANA (antinuclear antibodies) present
267
SS of Polyarticular juvenile rheumatoid arthritis?
- greater than 5 joints
- symmetric and affects small joints
- negative rheumatoid factor
268
What is poliomyelitis?
- polio virus causes lesions in the anterior horn and gray matter of the brain and spinal cord
269
SS of minor Polio?
- slight fever, HA, stiff neck, sore throat, vomiting
| - self-limiting in 24 to 72 hours
270
SS of major polio?
- fever, severe HA, stiff neck and back
- deep muscle pain, decreased dtrs flacid weakness, asymetrical muscle atrophy
- no sensroy loss
- progressive
271
What is the salk vaccine?
- inactivated polio vaccine
272
What is the sabine vaccine?
- live attenuated vaccine
273
Cause of rheumatic fever w/ monoarthritis of the hip?
- RF casued by S. pyogenes (group A streptococcus
- in children from 6 - 15 years
- previous strep infection
274
SS of RF w/ monoarthritis of the hip?
- tenderness and inflammation of the hip
- fever
- chorea
- subcutaneous nodules
- erythema marginatum
- carditis
- asciff bodies *** alwasy occur in RF
275
What is cholescystitis?
- inflammation of the gall bladder wall
276
Cause of cholescystitis?
- most commonly caused by gall stones
277
SS of Cholecystitis?
- recurrent colicky pain in the right upper quadrant that radiates through to the right lower scapula ** double check
- nausea
- abdominal guarding
- positive murphys sign
278
Demographics of Choleslithiasis?
- female
- fat
- 40
- flatulence
279
SS of choleslithiasis?
- epigastric of Right upper quadrant pain radiates to the right lower scapula
- biliary colic = progressive pain for 2 -3 hours then decreased nausea/vomiting
- fatty food intolerance
280
Imaging for cholelithiasis?
- ultrasound
281
Cause of pancreatitis?
- gall stones
| - alcohol
282
SS of pancreatitis?
- fever
- sudden onset of abdominal pain with radiation to the epigastric region or the back
- sitting up relieves the pain
- coughing sudden movement or deep breathing increases the pain
- nausea, sweating and increased HR
283
Lab results of pancreatitis?
- increase serum amylase***
- increase WBC
- decreased Calcium and albumin
284
What is chronic fatigue syndrome?
- 6 months of persistent fatigue and cognitive difficulties
| - 20s - 40s
285
SS of chronic fatigue syndrome?
- fatigue, short term memory impairment, sore thorat, tender lymph nodes, chest pain an palpitations, HA, depression, mood swings
286
SS of Retroesophageal Hematoma?
- the retropharygheal space is <7mm @ C3
| - the retrotracheal space is < 22mm @ C6
287
Cause of retroesophageal hematoma?
- most commonly an injured longus colli
288
Cause of bicipital tendonitis?
- repeated throwing or overhead work
289
SS of bicipital tendonitis?
- increased pain with flexion and hyperextension
- positive Yergasons, speeds and hyperextension test
- popping with flexion, abduction and external rotation
290
What is osgoode-schlatters disease?
- prominence of the tibial tuberosity may or may not be painful
- pain in the tibial tuberosity with kicking quad contraction ex. going up or down stairs
291
Causes of osgoode-schlatters?
- repeated traction by quads
| - commonly occurs in kicking sports
292
Osteoarthritis demographics?
- patient > 45
293
What are herberdens nodes?
- degradation which occurs at the DIPS in Osteoarthritis
294
What are bouchards nodes?
- degradation which occurs at the PIPs in osteoarthritis
295
What xray finding occurs in both RA or erosive RA?
- MCP involvement
296
SS of osteoarthritis?
- morning stiffness for < 30mins, this improves with activity
- decreased ROM, crepitus, enlarged painful joints
297
Xray findings of osteoarthritis?
- subchondral sclerosis
- asymmetrical loss of joint space
- subchondral cysts
- vacuum phenomenon
- osteophytes
298
Xray findings of erosive osteoarthritis?
- PIPs and DIPs have degradation
| - gull wing erosions of DIPs and PIPs
299
SS of erosive arthritis?
- warm, swollen joints
| - some foods increase swelling
300
Cause of patellar tendonitis (jumpers knee)?
- repetitive activity
| - jumping/spiriting
301
SS of Patellar tendonitis (jumpers knee)?
- patella tracking problem
- positive movie-goers sign
- pain on resisted extension
302
What is Patellofemoral pain syndrome?
- patella tracking problem because of weak Vastus medialis oblique or weak medial/lateral retinaculum
- pain caused by irritation of the fat pad
303
SS of patellofemoral pain syndrome?
- anterior knee pain
- increased pain with climbing up or down the stairs and sitting for long periods of time
- crepitus and pain with walking
304
What is Popliteal tendonitis?
- inflammation of the popliteal tendon
| - pain infront of the LCL where it inserts upon non weight bearing rotation of the knee
305
SS of politeal tendonitis?
- pain with resisted internal rotation at 30 degrees
| - lateral knee pain, specifically over insertion
306
Popliteal muscle function?
- pulls posterior-lateral meniscus posterior during knee flexion
307
Cause of AC joint sprain?
- direct or indirect trauma ex. FOOSH
308
SS of AC sprain?
- pain with passive abduction from 90 - 190 degress
- clavicle also rotates with passive abduction
- pain with passive horizontal adduction
309
What is a grade 1 AC joint sprain?
- AC ligaments small tear
| - still have full ROM
310
What is a grade 2 AC joint sprain?
- AC ligament completely torn
- coracoclavicular ligament intact
- slight step off of the clavicle in xray
311
What is a grade 3 AC joint sprain?
- AC ligament completely torn
- coracoclavicular ligament completely torn
- greater joint separation and larger clavicle step off
312
Most common spot for a clavicle fracture?
- in the lateral 1/3 and the middle
313
Demographics of adhesive capsulitis?
- women
- 40 - 65
- diabetes
- depression
314
SS of adhesive capsulitis?
- decreased ROM
- capsular pattern = external rotation and abduction
- hard end feel
- takes 2 yrs to completely recover
315
SS of stage 1 adhesive capsulitis?
- called pre adhesive stage
- minimal or no decreased in the ROM
- painful abduction and external rotation
316
SS of stage 2 adhesive capsulitis?
- acute adhesive synovitis
- painful arc of abduction
- slight decreased ROM
- constant pain and muscle atrophy
317
SS of stage 3 adhesive capsulitis?
- extreme loss of ROM then gradual improvement
318
Most common shoulder dislocation?
- anteriorly
| - occurs with excessive abduction and external rotation
319
SS shoulder dislocation?
- positive apprehension test, relocation test, jobes test
| - torn labrum can be associate with any GH dislocation
320
Entrapment sites of supraclavicular nerve?
- posterior aspect of the SCM
| - beneath platysma
321
Where does the supraclavicular nerve originate?
C3 C4 from the cervical plexus
322
SS of supraclavicular entrapment?
- pain in the anterior-superior shoulder thus a diffuse ache/pain in this area
323
Cause of Supraspinatus tendonitis?
- occurs because large eccentric load
324
SS of supraspinatus tendonitis?
- pain and weakness with shoulder abduction and external/internal rotation at 90 degrees
- positive neers (subacromial impingement), empty can and Hawkins Kennedy
325
Cause of shoulder impingement?
- repetitive overhead work/activity
326
SS of shoulder impingement?
- refered pain to the lateral deltoid, posteriolateral arm and elbow
- pain with abduction (70 - 120 degrees)
- painful catch at 180 degrees
- positive neer, hawkins kennedy, empty can
327
SS of costovertebral subluxation?
- pain over the non-articulating tubercle of rib
- shar, stabbing pain about the size of a dime
- pain with deep inspiration or direct pressure
328
SS Metacarpal fracture?
- pain and swellin
| - pain with vibration
329
Cause of achilles tendonitis?
- increased running and jumping
| - trauma with forced dorsiflexion
330
SS of achilles tendonitis?
- pain at the beginning of activity or in the morning which goes away after warming up or prolonged activity
- pain with palpation
- pain with passive/active dorsiflexion
- possible scar tissue if chronic
331
Treatment of Achilles Tendonitis?
- rest and ice
| - refer to MD for NSAIDS
332
Cause of anterior talo-fibular ligament sprain?
- 85% ankle sprains = inversion
| - too much inversion = sprain
333
SS of grade 1 anterior talo-fibular sprain?
- no tear
- slight ROM decrease
- slight pain
- min swelling
- usually no bruising
- can fully weight bear
334
SS of grade 2 anterior talo-fibular sprain?
- partial tear (10-50%)
- moderate loss of ROM
- severe pain
- moderate swelling
- bruising
- somewhat difficult to weight bear
335
SS of grade 3 anterior talo-fibular sprain?
- full tear >50%
- severe loss of ROM and no end feel
- pain but not as much as grade 2
- a lot of swelling
- brusing
- very difficult to weight bear
336
Treatment of grade 1 anterior talo-fibular sprain?
- rest ice and co-mange
337
Treatment of grade 2 anterior talo-fibular sprain?
- rest ice and co-mange
338
Treatment of grade 3 anterior talo-fibular sprain?
- refer to an ortho
339
Orthopeadeic tests used to diagnose anterior talo-fibular sprain?
- anterior drawer
| - talar tilt
340
X-ray Ottawa Ankle Rules?
- pain over malleolar zone and one of 3
- > tenderness along distal 6 cm of posterior edge of the tibia or tip of the medial malleolus
- > bone tenderness along the distal 6cm of the posterior edge of the fibula or tip of lateral malleous
- inability to weight bear or walk 4 steps
341
X-ray ottawa foot rules?
- bone tenderness at the base of the 5th metatarsal
- bone tenderness at the navicular bone
- inability to weight bear or walk 4 steps
342
Causes of a calcaneal bone spur?
- ossification and calcification resulting from traction of the plantar fascia on the periosteum of the calcaneous (inferior surface)
- increased standing, running, walking, obesity
343
Where do calcaneal bone spurs most commonly occur?
- medial calcaneal tuberosity where the plantar fascia attaches
344
What can be related to bone spur?
- reiter's disease (reactive arthritis), AS, DISH
345
SS of Calcaneal bone spur?
- pain on plantar aspect of the foot
- pain with walking standing and relieved by rest
- localized tenderness of medial calcaneal tuberosity
- swelling
- passive dorsiflexion of toes causes pain
- pain with first step in the morning
346
Xray finding of a calcaneal bone spur?
- lateral bone spur
347
Treatment for a calcaneal bone spur?
- heel lifts
- donut shoe inserts
- straussverg sock
- calf stretching
- night splinting
- shockwave
can comanage with an ortho
348
What is Charcot joints?
- a destructive neurotrophic arthropathy that occurs when a patients perception of pain and proprioception are diminished but their mobility is maintained
* destructive but painless
349
Underlying conditions associated with Charcot's joints?
- Diabetes mellitus (in foot)
- syphilis ( in hip and knee)
- syringomyelia (elbow knee and shoulder)
350
Where does Charcots joints most commonly occur?
Knee
351
SS of Charcot's joints?
- in early stages: recurrent painless effusions
- relativley painless instability or acute dislocation of joints
- enlargement and crepitus of bones
- gait disturbances
- Loss of DTRs and pain insensitivity
- neuro loss seen before arthritis
- can also be OA but Charcots has faster progression
352
Xray findings of Charcot's joints?
- Hyper trophic
- 6 D's:
- >distension
- >increased density
- >debris
- >disorganization
- >dislocation
- >dislocation
- >destruction
- most pronounced hypertrophic weight bearing joints
353
Demographics of Type 1 Diabetes Mellitus?
- Insulin dependent
- occurs at any age
- usually in childhood or adolescent <30
354
Causes of diabetes Mellitus type 1?
- autoimmune
| - insulin dependent because there is destruction of the beta cells in the pancreas
355
Risks of Type 1 Diabetes?
- diabetic ketoacidosis
| - kussmaul breathing
356
SS of Diabetic Mellitus Type 1?
- polyuria
- polydipsia
- weight loss
- bilateral peripheral neuropathy (stocking glove)
- diplopia, fatigue, nausea
- KID- restless, irritable, bed wetting, weakness, food cravings, polydipsia
357
Diagnostic tests for Diabetes Mellitus Type 1 and Type 2?
- fasting glucose is > 140 mg/dL (>7.7 mol/L)
| - gold standard = glycosylated Hb
358
Demographics of Diabetes Mellitus Type 2?
- non-insulin dependent
- >30 years
- most common in obese people
359
Cause of diabetes mellitus type 2?
- little insulin secreted from pancreas or the insulin receptors are not functional
360
SS of diabetes mellitus type 2?
- women have candidiasis (fungal growth in genital ex. yeast infection)
- arteriosclerosis
- infection
- diabetic retinopathy
- stocking - glove distribution of numbness and tingling
- ulcers
361
Treatment for Diabetes Mellitus Type 2?
- weight loss
- diet
- education
362
What is Gout?
- monosodium urate crystal deposition in joints
363
Demographics of a Gout patient?
- male > 40
364
What is hyperuricemia?
- occurs in gout
- decreased renal clearance of urate
- increased purine synthesis b/c of tomato, meat or spinach
- deficiency of hypoxanthine- guanine phosphoribosyl transferase
365
Causes of gout?
- fatigue
- surgery
- trauma
- emotional stress
- increased purine because tomato, meat or spinach
366
SS of gout?
- usually monoarticular
- Podagra = gouty toe -> swollen, red, painful
- crystallization of uric acid in joints = painful joints
- increased blood pressure
- nocturnal pain
- skin sloughing after 7 days of acute attack
- fever, tachycardia, chills, malaise, leukocytosis may occur
- uric acid kidney stone = uricemia
367
Xray findings of gout?
- soft tissue swelling at the joint
- tophi
- preservation of joint space***
- periarticular, marginal and intraosseous boney erosions
- chondrocalcinosis = CPPD another disease deposition of calcium
- overhangin margin sign = phalange overhangs due to erosions
- spotty carpal sign (unilateral)
368
Diagnostic tests for gout?
- increased serum urate > 7mg in blood work
| - needle shaped urate crystals in joint fluid or engulfed by phagocytes in culture
369
Treatment for Gout?
- refer to MD, colchicine, allopurinol,
| - co-manage: weight loss, diet, education, tart cherry juice
370
Risks associated with gout?
- hypertension
| - kidney disease/stones
371
Differentials for gout?
- CPPD
| - RA
372
Cause of Hallux Rigidus/Limitus?
- biomechanics = limitation of ROM in big toe
| - genetics
373
SS of Hallux Rigidus?
- pain/swelling/synovitis of joint
- pain with extension of big toe or restricted dorsiflexion of big toe
- bunion, hallux valgus
374
Differentials of Hallux Rigidus?
- metatarsalgia
- sesamoiditis
- arthritis
- neuritis/neuroma
- ulceration
- tendonitis
375
Xray finding of Hallux Rigidus?
- arthritic changes in the 1st MTP joint
376
What is hallux valgus?
- lateral deviation of the first MTP joint
377
Cause of hallux valgus?
- OA
- over-pronation
- tight shoes
- trauma
378
SS of hallux valgus?
- bunion
- pain at 1st MTP joint
- lateral deviation of 1st ray
- increased dorsiflexion of distal phalanx
379
Treatment of hallux valgus?
- traction
- orthotics
- co-manage: NSAIDs, surgery
380
What is Morton's Neuroma?
- neuroma (persistent thickening of perineurium) of the interdigital nerve
- occurs more in W than M
381
Where does Morton's Neuroma most commonly occur?
- between 3rd and 4th digits
| - 3rd plantar interdigital nerve is a branch of medial and lateral plantar nerves
382
Cause of Morton's Neuroma?
- poor shoe support
| - trauma
383
SS of Morton's neuroma?
- sudden pain along the foot radiating to ball or toes
- burning sensation or tingling
- marble or pebble like feeling on the ball of foot
384
Diagnostics of Morton's neuroma?
- forefoot squeeze (morton's squeeze test)
385
Treatment of Morton's neuroma?
- proper footwear
| - refer to ortho: lidocaine, corticosteroids, surgery
386
What is osteochondritis Dissecans?
- loss of blood supply to an area beneath the joint surface (AVN)
- cartilage loosens and bone detaches into the joint
- if an adult = SONK (spontaneous osteonecrosis of the knee)
387
Where does osteochondritis Dissecans most commonly occur?
- in the knee
- > specifically the lateral part of medial femoral condyle
- adolescent or young adult
388
SS of osteochondritis dissecans?
- anteromedial joint line pain
- swelling and intermittent locking
- crepitus and catching
389
Diagnostics of osteochondritis dissecans?
- positive wilsons test
390
Xray findings of osteochondritis dissecans?
- fragmentation
- scalloped lateral aspect of medial femoral condyle or talar dome
- joint mice is also possible
391
What is Osteoid Osteoma?
- painful benign overgrowth in long bones
| - occurs in people from 10 - 25 years old
392
SS of osteoid osteoma?
- pain, worse at night
| - relieved by aspirin
393
Xray findings of osteoid osteoma?
- 1cm of lucency surrounded by sclerosis = nidus
| - cloud like shape with a white dot on the inside
394
Differentials of Osteoid Osteoma?
- brodie's abscess results from an infection
395
Causes of Raynaud's disease?
- idiopathic
- in young women
- ass. w/ migranes, variant angina, pulmonary hypertension
396
What is raynaud's disease?
- it is when exposure to cold or strong emotion can cause the arteries to constrict most commonly in the hand and feet becoming cold
397
What is Raynaud's Phenomenon?
- secondary raynaud's usually because of an obstruction
| - similar to raynaud's disease but decreased BP in digital arteries at rest
398
What is raynaud's phenomenon associated with?
- decreased BP
- scleroderma, Ra and SLE
- obstructive arterial diseases (arteriosclerosis obliterans, thromboangitis obliterans/buerger's
- myxedema
- pulmonary hypertension
- trauma
- drugs = clonidine, B-blocker, ergotamine
399
SS of Raynaud's phenomenon?
- intermittent attacks of pallor and cyanosis of digits precipitated by exposure to cold or emotional stress
- attacks of pallor last minutes to hours
- color changes are usually patchy
- only one finger or toe may be affected
- Biphasic= cyanosis then reactive hyperaemia
- Triphasic = pallor, cyanosis and reactive hyperaemia
- no color changes proximal to the MCP, rarely involve thumb
- relieved by warming up the area
- no pain
- minimal trophic changes and gangrene are absent or minimal
- in long standing disease SS progress to trophic changes
400
How to diff Raynauds disease from Raynauds phenomenon?
- disease=
- > bilateral
- > no ss of underlying disease
- > no trophic or gangrene skin change
- > pulses present
- > history of symptoms 2 yrs without progression
- phenomenon=
- > unilateral
- > ss of underlying disease ex. SLE and scleroderma
- > can progress to gangrene
- pulses are eventually lost
401
Treatment of Raynaud's?
- stop smoking
- protect body from warm/cold extremes
- sedatives for stress/relaxation techniques
- calcium channel blockers
- sympathectomy
402
What is reiter's syndrome?
- arthritis after GU or GI infection
403
SS of Reiter's syndrome?
- conjunctivitis = can't see
- urethritis = can't pee
- polyarthritis = can't dance, asymmetric and polyarticular most commonly the knee
- fever
- enthesopathy = pain at heel or the patellar tendon
- back pain
404
Most common cause of Reiter's syndrome?
- chlamydia trachmatis
| - in men in 20-40
405
Diagnostic results of Reiter' syndrome?
- negative rheumatoid factor
| - positive HLA-B27
406
Xray results of Reiter's syndrome?
- asymmetrical ray patterns usually in the DIPs
- gull wing erosions
- unilateral sacroiliitis (commonly B/L asymmetrical)
- non-marginal syndesmophytes in the T/L
- might have an increased ADI
- enthesopathy of the achilles
407
Treatment for Reiter's syndrome?
- refer to MD for tetracycline
| - do not adjust during the inflammatory page
408
What is Rheumatoid Arthritis?
- systemic autoimmune disease targeting synovial tissue
409
Demographics of Rheumatoid Arthritis?
- W>M
| - 25 - 50 yrs
410
SS of rheumatoid arthritis?
- insidious onset with progressive joint involvement
- symmetric inflammation, PIPs, MCP, MTP, wrist, elbow, ankles
- tenderness over inflamed joints
- synovial thickening ex. bouchard's nodes at PIPs
- morning stiffness for > 30 min
- fever, fatigue and weight loss
- ulnar drift, swan neck or bouteneire deformity
411
Diagnostics results of rheumatoid arthritis?
- positive rheumatoid factor
- increased ESR and CRP
- mild anemia
412
Xray findings of rheumatoid arthritis?
- PUBES
- periarticular soft tissue swelling
- uniform loss of joint space
- ulnar styloid erosions
- bilateral symmetry
- marginal erosion
- subchondral bone cysts
- juxta-articular periostitis
- deformity
- spotty carpal sign = multiple lucent erosions
- squashed carpal sign
- terry thomas sign
- arthritis mutilans
413
Xray finding of Rheumatoid Arthritis in the cervical spine?
- dens erosions
- lateral mass erosions
- tapered SP
- eroded/fused facets
- disc space
- ADI narrowing
- protrusio acetabuli = otto's oelvis
414
Treatment of Rheumatoid Arthritis?
- co-manage and refer to a rheumatologist
415
Causes of septic arthritis?
- bacterial: gonococcal = N. gonorrhea (gram negative)
| - viral: parvovirus B19, hepatitis B and V rubella
416
SS of septic arthritis?
- acute, sudden onset of joint pain and swelling
- moderate severe joint pain
- warm tender and decreased ROM
- general fatigue
417
Diagnostic results for septic arthritis?
- increased ESR
- increased CRP
- WBC > 20 000/uL
- decreased protein
- decreased glucose
- during bacterial culture -> gram stain is red
418
Xray findings of Septic Arthritis?
- Lytic destruction on both bones of a joint
- joint space will be different
- monoarticular unless in the spine
419
What is sever's disease (calcaneal apophysitis)?
- painful cartilage break in the calcaneus
420
Cause of sever's disease?
- vigorous activity
| - occurs mostly in ages 8 - 16 when the ossification centers are held together by interosseous ligament
421
SS of sever's disease?
- heel pain with walking
- limp
- history of trauma or repetitive strain
- warmth and swelling
- xray is not helpful but may show heel spurs
422
Treatment for sever's disease?
- heel lifts
- stretch hamstrings/calves
- RICE
- NSAIDS
423
Cause of Posteriolateral Talar Tubercle Fracture?
- forced plantar flexion ex jumping in basketball
| - talus hits the posterior-inferior lip if the tibia
424
SS of Posteriolateral Talar Tubercle Fracture?
- pain and swelling behind ankle
- difficulty walking down stairs or hills
- pain with plantarflexion
- pain with dorsiflexion of big toe b/c Flexor Hallicus Tendon runs through tubercles of the posterior process of talus
425
What is Tarsal Tunnel Syndrome?
- compression of the posterior tibial nerve as it runs through the tarsal tunnel (medial ankle) and divides into medial and lateral plantar nerves
426
Cause of Tarsal Tunnel Syndrome?
- synovitis of Tibialis posterior, Flexor Digitorum longus, Flexor digitorum hallicus
- inflammatory arthritis
- edema
427
SS of Tarsal Tunnel Syndrome?
- pain (burning or tingling) around ankle into toes
- pain is worse when walking and relieved by rest
- positive tinnels tap at tarsal tunnel
- swelling indicates other cause ex. fracture RA
428
Treatment of Tarsal Tunnel Syndrome?
- tape foot or orthotics
- inverts foot to tension nerve
- NSAIDs
- corticosteroids
- surgery
429
What are varicose veins?
- dilated, tortuous superficial veins in the extremities, usually bilateral
430
Causes of varicose veins?
- primary: most commonly inherent weakness in the veins
- secondary: pregnancy
- prolonged standing does not cause varicose veins
431
SS of varicose veins?
- symptoms absent
- patient may experience fatigue, aching discomfort or slight swelling, relieved by leg elevation or compression stockings
- worse with menstruation
- tense and palpable superficial veins
- put pressure on the vein with the patient lying, then have them stand up and release to see if the veins fill quickly or slowly
432
Treatment of varicose veins?
- incurable
| - can use compression stockings
433
What is Venous Thrombosis (Thrombophlebitis)?
- Virchow's Triad = 1) injury to endothelium 2) Hypercoagulability 3) stasis
- most commonly affects saphenous vein
434
Causes of Venous Thrombosis (Thrombophlebitis)?
- bedrest
- pregnancy
- inactivity
- oral contraceptives
435
What is Superficial Venous thrombosis?
- pain, tenderness, erythema and warmth
- palpable linear cord
- requires referal
- contraindication to massage over area but not a red flag
436
What are the types of Deep Venous Thrombosis?
- acute Iliofemoral Deep Vein Thrombosis
| - acute DVT of the calf
437
What is acute iliofemoral deep vein thrombosis?
- dilated superficial collateral veins over the leg and lower abdomen
- due to lack of drainage from the blocked vein
438
SS of Acute Iliofemoral Deep Vein Thrombosis?
- edema in ankles, calves and may be entire leg
- tender hard cord in femoral triangle or medial thigh
- chronic venous insufficiency type symptoms:
- > fullness
- > aching
- > tiredness in leg with activity
- more likely to end in pulmonary embolism vs DVT in calf
439
What is Acute DVT of calf?
- 3 veins drain lower leg therefore thrombosis of one will not cause obstruction- not possible to see edema or dilation of superficial collateral veins
440
SS of Acute DVT of calf?
- soreness, pain on standing and walking, relieved by rest and elevation
- palpation reveals deep calf tenderness (not specific for calf DVT)
- Homan's sign pain with dorsiflexion and squeezing the thigh
- Peebody's sign = spasm of the calf
- Mose's sign = pain on squeezing calf muscles against the tibia
- Combination of: tenderness, pain, edema, warmth, skin discoloration and prominent superficial veins should warrant referral
441
What is Chronic venous insufficiency?
- fullness, aching, tiredness in leg and swelling
442
SS of chronic Venous insufficiency?
- occur during weight bearing and relieved with elevation
- history of previous thrombophlebitis
- no tenderness on palpation (however this is present in acute thrombophlebitis)
- normal temp and pulses may be hard to feel due to swelling
443
Treatment of Chronic venous insufficiency?
- refer to MD
| - heparin or other anti-coagulants
444
Cause of facet syndrome?
- irritation of capsule, facet and meniscoid
| - innervated by medial branch of PPR from above an below
445
SS of Facet Syndrome?
- localized LBP, may refer into butt/thigh but does not pass knee
- no neuro signs
- positive kemps and SLR past 70 degrees
446
Types of hypersensitivity reactions (allergies)?
- Type 1
- Type 2
- Type 3
- Type 4
447
Type 1 hypersensitivity reaction?
- immediate or anaphylactic hypersensitivity
- eczema, conjunctivitis, rhinorrhea, asthma, gastroenteritis
- takes 15 - 30 mins from the time of exposure to the antigen
- IgE, mast cell and basophil
- biopsy of the reaction site has mainly mast cell and eosinophils
448
Type 2 hypersensitivity reaction?
- cytotoxic, antibody mediated
- antibodies bind to antigens on cell surface
- ex. drug-induced hemolytic anemia, granulocytopenia and thrombocytopenia
- reaction from minutes to hours
- mediated by IgM or IgG
449
Type 3 hypersensitivity reaction?
- immune complex hypersensitivity
- ex. serum sickness, SLE, arthus reaction, aspergillosis, polyarteritis, rheumatoid arthritis
- reaction takes 3 - 10 hours after exposure to the antigen
- antigen is soluble and mediated by soluble immune complexes -> IgG
- antigen may be exogenous (chronic bacterial, viral or parasitic infection) or endogenous (non-organ specific autoimmunity)
450
Type 4 hypersensitivity?
- cell mediated or delayed hypersensitivity
| - ex. tuberculin (montoux) reaction which peaks 48 hrs after the injection of antigen = contact dermatitis
451
Risk Factors of Bronchogenic Carcinoma?
- smoking
- occupational/environmental irritants
- occurs in ages 45 - 70
452
What are the types of Bronchogenic Carcinoma?
- Squamous cell carcinoma (25 - 40%)
- Small cell carcinoma (20 - 25%)
- Adenocarcinoma (25 - 40 %)
- Pancoast Tumor
453
SS of bronchogenic carcinoma?
- Systemic
-> cough or change in cough
->hemoptysis, atelectasis
-> constant tiredness/fatigue, general discomfort
- weight loss
chest pain
shortness of breath
- hoarseness
- trouble swallowing
- pneumonia/fever
- wheezing
- extra pulmonary paraneoplastic symptoms
454
What is squamous cell carcinoma?
- 75% occur in smokers
- most commonly primary lung cancer
- found in bronchus (central)
- create a mass and resembles an abscess on xray
- metastasis: adrenal, liver, brain, bone
455
What is small cell carcinoma?
- centrally located (bronchus), does not form a mass (unlike squamous cell)
- highly malignant: prognosis of only 6 -12 months after diagnosis
- most commonly associated with smoking
- usually not detected until mets have already occurs
456
What is adenocarcinoma?
- most common in women and non-smokers
| - peripheral location, coin lesions (empty looking lesion)
457
What is a pancoast tumor?
- Horner's syndrome:
- > miosis
- >ptosis
- >anhydrosis
- ulnar nerve distribution type symptoms
458
What is scleroderma?
- chronic autoimmune disease
| - W>M
459
SS of scleroderma?
- fibrosis
- degenerative changes
- vascular abnormalities in skin and internal organs
460
What is CREST syndrome?
- limited cutaneous scleroderma
461
SS of CREST syndrome?
- Calcinosis
- Raynauds phenomenon
- esophageal dysfunction
- sclerodactyly- skin becomes taught and skinny, hyperpigmented and face is mask like
- telangiectasia
- affects hands arms and face
462
What is Diffuse systemic scleroderma?
- same as CREST but also affects internal organs
- Calcinosis
- Raynaud's phenomenon
- esophageal dysfunction
- sclerodactyly- skin becomes taught and skinny, hyperpigmented and face is mask like
- telangiectasia
- affects hands arms and face
- MSK: fibrin deposits in joints/tendons/bursa causes friction rub
- lung fibrosis, cardiac arrhythmias, renal insufficiency
463
Differentials of scleroderma?
- thickened skin
- raynauds
- ANA antibodies
464
What is Bromelain?
- proteolytic enzymes
- contributes to digestion of protein, may be used as a digestive aid
- found in the stem of pineapples
- available as a dietary supplement
- acts as an anti-inflammatory agent: -> helps heal sprain/strains
- > enhances rate of healing for frost-bite and burns
- > reduced post-operative swelling, brusing and pain
- > helpful w/ RA
- acts as a blood thinner
- > used to help decrease symptoms of angina or thrombophlebitis
- decreases mucous thickness in either asthma or chronic bronchitis
465
What is calcium needed for?
- muscle contraction, nerve conduction, hormone release and blood coagulation
466
Daily requirements of calcium?
- low intracellular CA
- 1000 - 1200mg
- but only 20 - 30% of ingested Ca is absorbed
- Children absorb more calcium than adults
- 99% stored in bones and teeth
467
What vitamin is required to absorb calcium?
- vitamin D
468
What is hypocalcemia?
- < 8.8 mg/dL
- muscle cramps
- tetany
- laryngospasm
- generalized convulsions
- long term:
- > Rickets
- > osteoporosis
469
What is hypercalcemia?
- usually b/c increased bone resorption
- constipation
- anorexia
- nausea
- vomiting
- abdominal pain and ileus
470
What is Cobalamin?
- Vitamin B12
471
Functions of Cobalamin?
- humans are the only animal to require B12
- required for methionine regeneration, converts homocystine to methionine
- helps with DNA synthesis
- RBC production
472
Sources of Cobalamin?
- only animal sources
| - liver, kidney, milk
473
SS of cobalamin (B12) deficiencies?
- most deficiencies are due to lack of Vitamin B12 absorption
- Pernicious anemia:
- > decreased gastric mucosa parietal cells = decreased secretion of intrinsic factor
- > macrocytic hyperchromic anemia, ovalocytes, multinucleated neutrophils, ovalocytes, multinucleated neutrophils (shift to right), band cells (shift to left)
- > glossitis (painful burning tongue)
- demyelination of neurons causes:
- > loss of vibration sense, unsteadiness, poor motor control, tingling/numbness, burning of feet
- mental slowness, confusion, psychosis (megaloblastic madness/dementia)
474
Diagnostics for cobalamin (B12) deficiency?
- Schilling Test: tests for intrinsic factor
475
What is Magnesium?
- high inside the cell
- 60% combined with calcium and phosphorus in bone
- kidneys release and absorb Mg based on requirements
- acts as a muscle relaxant 9compared to Calcium which acts as a stimulant)
476
Functions of Magnesium?
- general metabolism
- protein and DNA synthesis
- muscle action: nerve impulse transmission and a muscle relaxant
- affects BMR by influencing secretion of thyroxine which acts in cold adaptation
- causes release of PTH and acts on bones kidney and intestines
- involved in Vitamin D metabolism
477
RDI of Magnesium?
- 250 - 320 mg/day
478
Food sources of Magnesium?
- nuts, legumes, unrefined grains, green veggies, milk, cheese, meat, seafood, hard water
479
SS of Magnesium deficiency?
- high calcium blocks magnesium absorption
- vomiting diarrhea, surgical trauma, with prolonged use of Mg free fluids
- muscle weakness leading to a tetany like state***
- tremors change to convulsive seizures***
480
Functions of Chromium?
- aids glucose, lipid and protein metabolism
481
Sources of Chromium?
- brewers yeast, peanuts, wine, apples
482
SS of Chromium deficiency?
- poor insulin function
- glucose tolerance
- elevated cholesterol
483
What is Echineacea?
- herb used to reduce symptoms and duration of cold/flu
- exacerbated autoimmune conditions through overstimulation of the immune system
- individuals with a history of asthma, allergic hypersensitivity, allergic rhinitis
484
Adverse affects of Echinacea?
- tiredness
- somnolence
- dizziness
- headache
- GIT disturbance
- eczema
- immunosupression w/ prolonged use
485
What is fibre?
- undigestible complex of CHO found in plants
486
What is water soluble fiber?
- slows digestion and absorption of CHO and prevents some absorption of fats
- reduces serum cholesterol, may improve glucose tolerance (slow sugar absorption after a meal and decreased insulin)
- oat, oatbran, legumes and dried fruits
487
What is water insoluble fiber?
- bulks up waste and moves it through colon rapidly (decreased constipation and colon cancer)
- seeds, dried fruits, whole fruits, fibrous fruits and veggies and wheat bran
488
What is folic acid (B9)?
- water soluble B-Vitamin
489
Sources of Folic Acid (B9)?
- broccoli, spinach, orange
| - fortified breads/grains
490
SS of Folic Acid (B9) deficiency?
- lack of B9 in first trimester can cause spina bifida and other congenital deformities
- anemia
- glossitis
- depression
- birth defects
491
Function of Folic Acid (B9)?
- protein synthesis
- cell growth
- fetal development (may protect against heart disease, cervical and colon cancer)
492
What is Glucosamine/Chondroitin Sulfate?
- proteoglycans of amino sugars are called glycosaminoglycans, they interact with collagen
- commonly used in OA
493
Contraindications to Glucosamine?
- seafood allergy
- active peptic ulcers
- people on diuretics
494
What is iron used in?
- Ferritin: binds and transports iron
- Transferrin: transports iron in plasma
- Hepcidin: within liver, regulated iron homeostasis
- Ferroportin: exports iron into plasma from enterocyte when needed
495
What is Malic Acid?
- hydroxysuccinic acid
| - comes from apples
496
Function of Malic Acid?
- deriving ATP from food
497
What is Methylsulfonylmethane?
- naturally occuring sulphur compund
- acts as a sulfur donor to broken covalent disulfide bonds which are important in CT structure
- combination with glucoasmine reduces pain and inflammation in patients with RA
498
What is Thaiamine (B1)?
- required in the form of TPP (thiamine pyrophosphate
499
What enzyme require Thaiamine (B1) in order to function?
- Pyruvate Pyrophosphate (converts pyruvate to acetyl CoA
- Alpha-ketoglutarate dehydrogenase (converts alpha-ketoglutarate to succinyl-CoA)
- Aminoacid decarboxylases ( converts tryptophan to Niacin)
- Transketolase (Hexose-monophosphate shunt)
500
Function of Thiamine (B1)?
- glucose oxidation/kreb's
- healthy functioning of nerve and brain cells
- niacin synthesis
- TPP helps with conversion of trypotophan to niacin
501
What are the sources of Thiamine?
- sunflower seeds
- peanuts
- wheat brain
- beef
- liver
- pork
- seafood
- egg yolk
- beans
502
SS of Thiamine (B1) deficiency?
- slow and unsteady gait
- severe disturbances in posture, equilibrium, mental confusion and possible coma
- wet beriberi
- dry beriberi
- infantile beriberi
503
SS of wet BeriBeri?
- heart dysfunction
- symptoms on physical exertion
- edema
- numbness in legs
- irritability
- vague uneasiness, disorderly thinking
- nausea
- heart failure
- death
504
Treatment of Wet BeriBeri?
- increase thiamine intake
505
SS of Dry BeriBeri?
- polyneuritic nerve dysfunction, bilateral and dysfunction
- associated with low calorie diet and inactivity
- numbness in toes/legs
- irritability
- vague uneasiness
- disorderly thinking
- nausea
506
SS of Infantile BeriBeri?
- affects the brain, nerves and heart
- breast fed but poor in thiamine
- first notice symptoms at 2 - 5 months
- cyanosis
- tachycardia
- vomiting
- convulsions
507
Causes of Wernicke Koraskoff syndrome (cerebral BeriBeri)?
- 3 factors: alcohol, poor diet, genetics
| - these can impair thiamine absorption in jejunum and ileum
508
SS of Wernicke Koraskoff syndrome (cerebral BeriBeri)?
- mental confusion
- loss of balacne
- muscular incoordination
- visual problems
- coma
- death
- irreversible
509
What is Riboflavin (B2)?
- manufactured in the body by intestinal flora, easily absorbed as riboflavin, small amount stored
- facilitated essential co-enzyme in dehydrogenase reactions
510
What enzymes require Riboflavin (B2)?
- essential in dehydrogenase reactions
- enzymes requiring FMN or FAD
- G3P dehydrogenase (Glucose to G3P)
- Pyruvate dehydrogenase (Pyruvate to Acetyl to CoA)
511
Functions of Riboflavin (B2)?
- functions as FAD and FMN
- FAD in Fat and protein metabolism specifically KREB's cycle
- transfers hydrogen ions to ETC (FADH)
- aids in conversion of tryptophan to niacin
- activates Vitamin B6 (Pyridoxine)
512
Sources of Riboflavin (B2)?
- yeast, liver, organ meats, dairy products, whole or enriched grains
513
SS of Riboflavin (B2) Deficiency?
- early symptoms: cheilosis, angular stomatitis, magenta tongue, glossitis, seborrheic dermatitis, weakness, photophobia, corneal vascularization, anemia
- late symptoms: depression, hypochondria, scaly skin rash, reduced muscle strength, irritation of eyes, infant growth retardation
514
Who is at risk of Riboflavin (B2) deficiency?
- alcoholics: decreases Vitamin B2 absorption in the intestines
- strict vegetarian diets- b/c low B2 availability
515
Function of Niacin (B3)?
- required for epithelial cell turnover
- substrate for NAD used in dehydrogenase reactions (CHO, protein, fat metabolism)
- sex hormone synthesis
516
Sources of Niacin (B3)?
- liver meat
- poultry
- legumes
- nuts
- milk
- grain
- fruits
517
SS of Niacin Deficiency?
- Pellagra: bilateral dermatitis, diarrhea, dementia, death
| - CNS irritability, headache, sleepiness, loss of memory, hallucinations, severe depression
518
Treatment of Niacin deficiency?
- megavitamin therapy
- treatment reduce cholesterol
- Nicotinic acid can cause skin flushing
519
Function of Pyridoxine (B6)?
- TRANSAMINATION of amino acids
- homocysteine metabolism
- glycogen degradation
- RBC and Hb synthesis
- NT synthesis (GABA, NE, serotonin)
520
SS of Pyridoxine (B6) deficiency?
- peripheral blood vessel problems due to decreased homocysteine break down
- anemia: b/c vitamin B6 needed for heme synthesis
- neuron dysfunction: decreased neurotransmitter synthesis
- seborrheic dermatosis, glossitis, chilosis, peripheral neuropathy, lymphopenia
521
Who is at risk for Pyridoxine (B6) deficiency?
- at risk:
- alcoholics
- cirrhosis
- consumption of oral contraceptives
522
Function of Turmeric?
- aids in digestion
- prevents ulcers
- protects liver
- helps prevent heart disease
- stimulated bile flow, decreases cholesterol, decreases coagulation
- antibacterial in food therefore decreased spoilage, helps treat dysentry
** curcumin in tunmeric functions as an antiiflammatory
523
Sources of Vitamin A (retinol)?
- fish
- liver
- egg yolk
- butter
- beta carotene in green vegetable is converted to retinol in the small intestines
524
SS of vitamin A (retinol) deficiency?
- growth retardation
- night blindness
- hazy dry cornea
525
Function of Vitamin E?
- antioxidant, formation of DNA/RNA and RBCs
526
SS of Vitamin E deficiency?
- mild haemolytic anemia
- spinocerebellar disease (ataxia)
- loss of DTRs with diminished vibratory and position sense
527
Functions of Vitamin C?
- collagen
- wound healing
- dentition
- helps release free folic acid
- helps with absorption of iron and copper
528
SS of Vitamin C deficiency?
- scurvy with hemorrhagic manifestations
- weakness
- weight loss
- splinter hemorrhages
- bleeding gums
- breakdown of old scars
- delayed healing of new scars
- bruising
- TRIAD: - bruising, bleeding of gums, splinter haemorrhages
529
Functions of vitamin D?
- increases Ca absorption
- bone formation
- mineralization
530
Forms of Vitamin D?
- D2 = Ergocolciferol is found in yeast
| - D3 = cholecalciferol is found in human skin and is formed by U/V radiation exposure
531
SS of Vitamin D Deficiency?
- Rickett's: soft bones, bowing, restless, poor sleep, frontal bossing, enlargement of epiphyseal cartilages, delayed walking
- osteomalacia in adults: soft bones, pseudofractures, bowing
532
What is the most common area affected by Vitamin D Deficiency?
- most common area affected is distal radius and ulna with increased joint spaces between them
533
Function of Vitamin K?
- controls the formation of coagulation factors (within the liver)
- requires calcium to work
534
SS of Vitamin K deficiency?
- Hypoprothrombinemia: decreased coagulation causing easy bruising, nose bleeds, GI hemorrhage, menorrhagia, hematuria
- Hemorrhagic disease in newborn: 1 - 7 days post-partum; cutaneous, GI, intrathoracic and/or intracranial bleeding
- late hemorrhagic disease: 1 to 3 months post-partum
- adults at risk: trauma, extensive surgery, high dose antibiotics, anticonvulsants
535
What is Polyuria?
>2000 mL/day
536
What is Oliguria?
<500 mL/day
537
What is Nocturia?
>500 mL/day
| - decreased specific gravity
538
What is anuria?
- no urine output
539
What is normal urine excretion?
- 750 to 1500 mL/day
540
What is Hyponatremia?
- Low sodium
| - high h20
541
Causes of Hyponatremia?
- aldosterone deficiency
| - diuretic therapy
542
SS of Hyponatremia?
- altered mental status
- lethargy
- confusion
- stupor
- neurovascular hyperexcitability
- convulsion
- coma
- death
543
What is Hypernatremia?
- high sodium
| - low H20
544
Causes of Hypernatremia?
- diabetes insipidus (decreased ADH, decreased urine)
- increased sweating
- vomiting
- diarrhea
545
SS of hypernatremia?
- thirst
- confusion
- seizure
- coma
- thrombosis
546
Sources of Zinc?
- liver
- eggs
- seafood
547
SS of Zinc deficiency?
- anorexia
- growth retardation
- delayed sexual maturation
- hypogonadism
- alopecia
- dermatitis
- night blindness
- impaired wound healing
- acrodermatitis enterpathica: inherited recessive disorder causing zinc malabsorption, psoriasiform dermatitis, hair loss, paronychia, growth retardation, diarrhea
548
Most common area for cervical disc herniation?
- C5/C6
549
Which spondyloarthopathies look the same on x-ray
- Ankylosing Spondylosis and enteropathic arthritis
| - specifically bilateral sacroiliitis
550
Which IVFs do LAO and RPO cervical oblique xrays show?
- Left IVF
551
Which IVFs do RAO and LPO cervical obliques xrays show?
- Right IVF
552
Which IVFs are shown on anterior obliques?
- IVF and pars on opposite side of marker
| - ex. LAO = R IVF and pars
553
Which IVFs are shown on posterior obliques?
- IVF and pars on same side as marker
| - ex. RPO = R IVF
554
What is spondylitis?
- inflammation of the vertebrae
555
What is spondylosis?
- degenerative OA of vertebrae
556
What is spondylolisthesis?
- break in the pars and slippage of the vertebrae
557
What is Spondylolysis?
- break in the pars
558
Xray findings of whiplash associated disorder (WAD)?
- interspinous widening
- anterior slippage
- intersegmental flexion of SP
559
What is ALS?
- autoimmune disease affecting people >50
| - it is progressive and is caused by the degraation of motor neurons both UMN and LMN
560
SS of ALS?
- muscle weakness and atrophy
- muscle fasciculations
- slurred speach
- hyperreflexia
- positive babinskis sign
561
What is Springomyelia?
- a cyst that forms within the spinal cord
562
SS of sprinomyelia?
- loss of pain and temp begining in the fingers spreading in a shawl like patteren over the back and shoulder
- atrophy
- occurs with arold charii malformation
563
What causes a HA in a child?
- dehydration ins the most common cause
| - but alos tension, rebound, migrane
564
How does a child migrane differ from an adult migrane?
- lasts from 1 - 4 hrs
- paroxysmal throbbing, pulsating, retroorbital
- no abdominal pain in adult but in c hild there will be abdominal pain
- photophobia and phonophobia are present
- aura is not present in children
565
What does excess vitamin E cause?
- GIT distree
| - also causes supression of other antioxidants and increases the risk of heamorragic stroke
566
Excess Vitamin D?
- hypercalcemia
| - constipation
567
What mineral is least toxic to the body in excess?
-zinc
568
What are the most toxic vitamins?
- D (most likley to be taken in excess and E which has the most harmful effects
569
Waht does Vitamin B6 deficiancy cause?
- Dorsal Root Ganglion Degeneration
570
SS of vitamin B6 deficiancy?
- causes sensory peripheral neuropathy
571
What causes subacute degradation of the spinal cord?
- B12 deficiancy
| - Thiamin- Beri Beri
572
What innervates the sciatic nerve?
- L4-S2
| - nerve tensioning tests: SLR, well leg raise, braggards, bowstrings
573
What does a high CHO diet cause?
- salivary amylase begins breakdown in mouth
- increased glucagon production
- increased glucose -> increased insulin -> glucagon's in tissue for storage
574
Why do athletes not have as much lactic acid build up?
- increase 2 means that there isnt anerobic respiration occuring (converts pyruvate to lactic acid in the muscle) this is later converted back to pyruvate in the liver when oxygen becomes more readily available
575
Contraindications to Heat Therapy?
- acute injury
- open wounds
- neuropathy
- Multiple myeloma
- myositis ossificans
- DVT
- infection
- circulatory problems
576
What frequency does deep ultrasound use?
- 1 Mz
577
What frequency does superficial ultrasounduse?
3 Mz
578
What type of ultra sound produces heat?
- continuous
579
What type of ultrasound does not produce heat?
- pulsed
580
Contrindications to ultrasound?
- cancer
- over eyes ears, gonads, brain and spinal cord
- cancerous
- pregnancy
- over lung fields
- TB
- decreased sensation (risk of periosteal burns)
581
Where is the most common location of osteosarcoma?
- the knee
582
Xray findings of an unstable compression fracture?
- step defect, wedge deformity, linear zone of condensation, endplate displacemnt, paraspinal swelling, abnormal small bowl gas
- decreased disc space
583
Most common location of a unstable compression fractyure?
- T12-L1
