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Part B Canadian Boards > Diagnosis > Flashcards

Diagnosis Flashcards

1
Q

What can pain at night mean?

A
  • malignancy
  • fracture
  • bursitis
  • gout
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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
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3
Q

Symptoms of a Benign Breast tumour?

A
  • tender and movable

- ddx fibocystic breast disease

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4
Q

Symptoms of a Malignant breast tumour?

A
  • firm and non-movable
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5
Q

Where is the most common spot for a malignant breast tumour?

A
  • in the axilla
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6
Q

Where is the most common location for a meniscus tear?

A
  • posterior corner
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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
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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%
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9
Q

What tis the most common type of brain aneurysm?

A

Berry Aneurysm

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10
Q

What is the most common cause of a subarachnoid hematoma?

A
  • berry aneurysm
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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
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12
Q

What Diagnostic tests help to confirm aneurysm?

A

CT scan shows blood

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13
Q

Symptoms of Cranial Nerve Damage: 1 Olfactory?

A
  • anosmia = loss of smell
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14
Q

Symptoms of Cranial Nerve Damage: 2 Optic?

A
  • Bilateral hemianopia = optic chiasma compression
  • temporal hemianopsia
  • nasal hemianopsia
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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

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16
Q

Symptoms of Cranial Nerve Damage: 4 Trochlear?

A
  • superior oblique does not work

- can not turn eye down and in

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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
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18
Q

Symptoms of Cranial Nerve Damage: 6 Abducens?

A
  • lateral rectus does not work

- can not turn eye outward

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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
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20
Q

Symptoms of Cranial Nerve Damage: 8 Vestibulocochlear?

A
  • decreased hearing
  • nystagmus
  • vertigo
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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
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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
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23
Q

Symptoms of Cranial Nerve Damage: 11 Spinal Accessory?

A
  • paralysis of SCM = can not rotate head to opposite side

- shoulder drop

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24
Q

Symptoms of Cranial Nerve Damage: 12 Hypoglossal?

A
  • Hemiparalysis of tongue

- Tongue deviates toward side of lesion

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25
Q

What innervates the facets?

A
  • medial branch nerve
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26
Q

What is Glaucoma?

A
  • slow and progressive increase of fluid in eye

- most common cause of blindness

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27
Q

What are the signs and symptoms of Glaucoma?

A
  • 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
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28
Q

What are the different types of Hematoma?

A
  • Subarachnoid
  • Subdural
  • Epidural
  • Intercerebral
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29
Q

What is a subarachnoid hematoma?

A
  • a hemorrahage in the subarachnoid space caused by
    1. berry aneurysm’s in old people
    2. A-V malformation in young people
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30
Q

What is a subdural hematoma?

A
  • venous bleedings
  • slow onset of symptoms after head injury
  • takes hours-weeks for symptoms to come on
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31
Q

What is epidural hematoma?

A
  • rupture of middle meningeal artery via fracture of temporal/parietal bones
  • short lucid interval followed by rapidly developing
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32
Q

What is an intracerebral hematoma?

A
  • is caused by hypertension

- associated papilledema

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33
Q

What are the levels of adverse drugs reactions?

A
  • Mild: no antidote
  • Moderate: require change in drug
  • Severe: life threatening
  • Lethal: death
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34
Q

What are some factors that affect adverse reactions from drugs?

A
  • drug type
  • route
  • duration of therapy
  • dose
  • bioavailability
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35
Q

What are signs and symptoms of substance abuse?

A
  • withdrawal
  • constant intake
  • CAGE: cut down, annoyed, guilty, eye (when open eyes in the morning need to drink)
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36
Q

What is the causative agent of Bacterial Meningitis in neonates (meningococcal)?

A

E.coli

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37
Q

What is the causative agent of Bacterial Meningitis in children?

A

H. influenza

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38
Q

What is the causative agent of Bacterial Meningitis in Adults (pneumococcal)?

A

Strep Pneumoniae

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39
Q

What are the signs and symptoms of bacterial meningitis?

A
  • 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
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40
Q

What is Waterhouse-Friderichsen syndrome?

A
  • bilateral adrenal hemorrhage
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41
Q

What are the differences in the CSF b/w bacterial and viral meningitis?

A
  • Bacterial: cloudy, neutrophils, decreased glucose, increase protein
  • Viral: clear, normal glucose and proteins, increased lymphocytes
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42
Q

What is a VBI?

A
  • a vertebrobasilar insufficiency which consist of brief neural abnormalities
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43
Q

What can cause a VBI?

A
  • emboli from carotid or vertebral artery
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44
Q

What are the risk factors for VBI?

A
  • high BP
  • atherosclerosis
  • heart disease
  • atrial fibrillation
  • diabetes mellitus
  • polycythemia
  • middle aged and elderly
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45
Q

What are the signs and symptoms of VBI?

A
  • 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
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46
Q

What is the treatment of VBI?

A
  • anticoagulants –> herparin, warfarin

- refer to the MD

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47
Q

What is Wallenberg’s syndrome?

A
  • occlusion of Posterior inferior cerebellar artery

- occurs because of an emboli

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48
Q

What are the symptoms of Wallenberg’s syndrome?

A
  • 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
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49
Q

What is Vertigo?

A
  • hallucination of self or environment movement

- feeling of spinning

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50
Q

What is Disequilibrium?

A
  • My balance is off, i might fall
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51
Q

What is presyncope?

A
  • I might pass out, I feel faint
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52
Q

What is lightheadedness?

A
  • I just feel dizzy
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53
Q

What are differentials of vertigo?

A

vestibular disorder

  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Otitis media
  • Meniere’s syndrome
  • labyrinthitis
  • acoustic neuroma
  • salt - retaining vertigo
  • brainstem dysfunction
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54
Q

What are differentials of Disequilibrium?

A

sensory/neuro dysfunction

  • cervicogenic
  • multiple sensory defects
  • anxiety
  • drug induced
  • parkisonism
  • alcoholic
  • senile gait
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55
Q

What are differentials of presyncope?

A

decreased cerebral profusion

  • orthostatic hypotension
  • vasovagal
  • unknown
  • cardiac
  • neurological
  • situational
  • psychogenic
  • metabolic/drug
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56
Q

What are differentials of light-headedness?

A

anxiety/depression

  • acute hyperventilation
  • panic disorder
  • hypoglycemia
  • pheochromocytoma
  • drug withdrawal
  • epilepsy (temporal lobe)
  • mitral valve prolapse
  • cardiac arrhythmia
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57
Q

What are the symptoms of peripheral vertigo?

A
  • sudden onset
  • intermittent w/ severe symptoms
  • affected by head position and movement
  • severe nausea and vomiting
  • motor function and coordination
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58
Q

What are the symptoms of central vertigo?

A
  • 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
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59
Q

What causes quick spins for a few seconds?

A
  • BBPV
  • vascular compression syndrome
  • seizure
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60
Q

What causes dizzness for a few minutes?

A
  • anxiety/panic disorder
  • meniere’s disease, migrane
  • migraine variant
  • TIA
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61
Q

What causes dizziness for hours to days?

A
  • Migrane
  • Meniere’s
  • infection: vestibular neuritis/labrynthitis
  • stroke
  • CNS lesions
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62
Q

What causes dizziness for days to weeks?

A
  • Migraine
  • Infection
  • stroke
  • CNS lesions
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63
Q

What is Labyrinthitis?

A
  • inflammation of the bony or membranous inner ear
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64
Q

What cause’s Labyrinthitis?

A
  • bactera or virus
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65
Q

What are the signs and symptoms of labyrinthitis?

A
  • vertigo for hours to weeks
  • nystagmus
  • ** no hearing loss
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66
Q

What are some complications that can occur with labyrinthitis?

A
  • meningitis

- facial nerve paralysis

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67
Q

What is Meniere’s Disease?

A
  • excessive endolymph in membranous labyrinth causing dilation
  • also known as hydrops
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68
Q

What are the demographics of Meniere’s disease?

A
  • occurs more in men

- from ages 20 - 50

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69
Q

What are the signs and symptoms of Meniere’s disease?

A
  • recurrent vertigo 20 mins to 2hrs
  • sensory hearing loss, tinnitus
  • fullness in ear
  • nausea
  • vomitting
    usaully unilateral but can be bilateral
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70
Q

How to treat Meniere’s disease?

A
  • comanage w/ MD

- SMT if makes it better cause is probably cervicogenic

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71
Q

What is an acoustic neuroma?

A
  • tumor of CN 8 vestibular division
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72
Q

Signs and Symptoms of Acoustic neuroma?

A
  • gradual hearing loss
  • tinnitus
  • dizziness
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73
Q

What is acute vestibular neuritis?

A
  • sudden onset of vertigo

- inflammation of CN 8 vestibular division

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74
Q

What causes acute vestibular neuritis?

A

viral infection in adolescents and young adults

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75
Q

Signs and Symps of Acute Vestibular Neuritis?

A
  • Vertigo 7 to 10 days
  • Nausea
  • nystagmus toward the affected side
  • no hearing loss or tinnitus
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76
Q

What is motion sickness?

A
  • 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
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77
Q

Signs and Symptoms of motion sickness?

A
  • nausea
  • vomiting
  • sweating
  • hyperventilation
  • malaise
  • salivation
  • increased appetite
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78
Q

What are some complications of motion sickness?

A
  • arterial hypotension
  • dehydration
  • depression
    all occur w/ proloned vomiting
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79
Q

What is Multiple Sclerosis?

A
  • progressive CNS disease w/ plaques of demyelination in the white matter of the brain and spinal cord and optic nerve
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80
Q

Demographics of Multiple Sclerosis?

A
  • 20 - 40 year old women
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81
Q

S and S of Multiple sclerosis?

A
  • 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
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82
Q

How to treat MS?

A
  • corticosteroids (comanage MD, neurologist)
  • rehab
  • gait training
  • ROM exercises
  • physical activity
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83
Q

What is Myringitis?

A
  • inflammation of tympanic membrane secondary to viral/bacterial infection
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84
Q

What causes Myringitis?

A
  • S. Pneumoniae
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85
Q

SS of Myringitis?

A
  • vesicles on tympanic membrane
  • sudden ear pain
  • hearing loss
  • fever
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86
Q

Causes of Obstructed External Auditory canal?

A
  • cerumen (wax)
  • objects
  • insects
  • tumors:
    ceruminoma: benign in outer 3rd
    Basal Cell/squamous cell carcinoma- develop on pinna
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87
Q

What is Otitis Media?

A
  • bacterial/viral infection of inner ear
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88
Q

Cause of Otitis Media?

A
  • 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
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89
Q

SS of Otitis media?

A
  • 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
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90
Q

Complications of Otitis Media?

A
  • Meningitis

- mastoiditis

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91
Q

Treatment of Otitis Media?

A
  • antibiotics
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92
Q

Differentials of Otitis Media?

A
  • chronic otitis media -> HX of tympanic membrane perforation, sensorineural hearing loss and no pain
  • serous otitis media -> effusion in middle ear, conductive hearing loss
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93
Q

Where do temporal bone fractures most commonly occur and what is the risk?

A
  • pterion

- risk of middle meningeal artery rupture = epidural hematoma

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94
Q

Signs and symptoms of temporal bone fracture?

A
  • impact
  • CSF leakage or bleeding from ear
  • Blue/black tympanic membrane
  • sensorineural hearing loss or facial paralysis
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95
Q

Imaging to diagnose temporal bone fracture?

A
  • CT scan
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96
Q

What is a temporal lobe seizure?

A
  • complex partial seizure

- looses contact with surrounding for 1 to 2 mins

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97
Q

SS of Temporal lobe seizures?

A
  • stare
  • purposeless movement
  • unintelligable words
  • hallucinations, vestibullar symps, spontaneous motor activity
  • mental confusion for few minutes after the motors components stop
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98
Q

What is a Petit-mal (absent) seizure?

A
  • 2 to 15 seconds of staring, longer = complrx partial
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99
Q

What is a Grand-mal (tonic-clonic) seizure?

A
  • jerky rigid movement

- lasts 2 to 5 mins

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100
Q

What is a Jacksonian seizure?

A
  • abnormal primary cortex activity
  • begins in hands and moves proximally
  • sudden contraction
    involuntary eye movement
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101
Q

What is a Hemothorax?

A
  • collection of blood in the pleural cavity?
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102
Q

Cause of Hemothorax?

A
  • ruptured aortic aneurysm, trauma
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103
Q

SS of Hemothorax?

A
  • Dyspnea
  • decreased chest expansion on side
  • hyperresonance
  • bronchial lung sounds
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104
Q

What is a Pneumothorax?

A
  • collection of blood in the pleural cavity (b/w visceral and parietal pleura)
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105
Q

Types of pneumothorax?

A
  • 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
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106
Q

SS of pneumothorax?

A
  • dyspnea
  • sharp chest pain
  • dry cough
  • mediastinal shift to opposite side
  • decreased breathing sounds
  • hyperresonance
  • bronchial lung sounds
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107
Q

What is Atelectasis?

A
  • lung collapse

- most commonly b/c bronchial obstruction

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108
Q

SS of atelectasis?

A
  • 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
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109
Q

Imaging for atelectasis?

A
  • x-ray
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110
Q

What does x-ray of a collapse lung show?

A
  • decreased lung size
  • elevated diaphram
  • deviated trachea/heart/mediastinum
  • solid airless area within lung
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111
Q

Treatment for atelectasis?

A
  • emerg

- suctioning, bronchoscopy, respiratory therapy

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112
Q

What is bronchiectasis?

A
  • 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
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113
Q

Cause of Bronchiectasis?

A
  • congenital = cystic fibrosis
  • childhood infection
  • inhalation of noxious chemicals
  • vascular abnormalities
  • immunogical reactions
  • bronchiole obstruction (foreign body)
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114
Q

SS of Bronchiectasis?

A
  • TRIAD:
  • > persistent productive cough
  • > copious purulent sputum
  • > hemoptysis
  • wheezing
  • dyspnea
  • crackles
  • decreased breath sounds
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115
Q

What is acute bronchitits?

A
  • inflammation of the tracheobronchial tree after upper respiratory tract infection (adenovirus, coronavirus)
  • self limiting for 7 - 14 days
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116
Q

SS of Acute Bronchitis?

A
  • 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
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117
Q

What is COPD?

A
  • airflow obstruction due to chronic bronchitis or emphysema and airflow obstruction
  • progressive and partially reversible
  • consists of Chronic bronchitis and emphysema
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118
Q

What is chronic bronchitis?

A
  • daily prodcutive cough for 3 consecutive months for 2 years
  • progressive partially reversible
  • BLUE BLOATERS = cyanotic b/c increase PCO2
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119
Q

What is Emphysema?

A
  • 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
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120
Q

SS of COPD?

A
  • cough that’s worse in the morning
  • colorless sputum
  • dyspnea
  • wheezing
  • cyanosis
  • right heart failure
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121
Q

Complications of COPD?

A
  • cor pulmonae )right sided heart failrue)
  • acture respiratory failure
  • pneumothorax
  • arrhythmia
  • pulmonary embolism
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122
Q

Treatment of COPD?

A
  • educate on not smoking b/c
  • > decrease bronchiole obstruction
  • oxygen therapy
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123
Q

What is asthma?

A
  • 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
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124
Q

SS of asthma?

A
  • 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
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125
Q

Treatment of asthma?

A
  • med from MD commange
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126
Q

What is Congestive Heart Failure?

A
  • 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
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127
Q

SS of Congestive heart failure?

A
  • asymptomatic at first
  • early symp: dyspnea with exertion and increased fatigue
    later: orthopnea
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128
Q

SS of Left heart failure?

A
  • 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
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129
Q

SS of Right sided heart failure?

A
  • low CO: dyspnea, tricuspid regurgitation
  • peripheral edema
  • hepatomegaly
  • hepatic tenderness
    increased jugular vein prominence
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130
Q

What is the cause and location of an Abdominal aortic aneurysm?

A
  • L3 and L4

- atherosclerosis/arteriosclerosis = most common casue

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131
Q

SS of Abdominal aortic aneurysm?

A
  • 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
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132
Q

Who is at risk for a thoracic aortic aneurysm?

A
  • ehler;s danlos
  • marfans
  • trauma
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133
Q

SS of Thoracic aortic aneurysm?

A
  • pain (spine and thoracic cage)
  • cough, wheeze hemoptysis
  • dysphagia
  • horners syndrome:
  • > miosis
  • > anhydrosis
  • > ipsilateral side
  • tracheal deviation away from aneurysm
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134
Q

What is Angina Pectoris?

A
  • myocardial ischemia
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135
Q

SS of angina pectoris?

A
  • chest pressure < 30 min
  • exertion, emotion, eating
  • relieved by rest and nitroglycerin
  • ST wave depression
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136
Q

What is a Myocardial infarction?

A
  • ischemia with myocardial necrosis due to decreased coronary blood flow
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137
Q

SS of Myocardial Infarction?

A
  • 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
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138
Q

What do Diagnostic tests show for Myocardial Infarction?

A
  • increased troponin I and T, ST wave elevation
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139
Q

What is Costochondritis?

A
  • localized pain and tenderness at costochondral junctions
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140
Q

SS of Costochondritis?

A
  • 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
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141
Q

What is Tietze syndrome?

A
  • unilateral inflammation/edema of one or more costochondral junction
  • most common in women > 50
  • type of costochondritis
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142
Q

What is GERD?

A
  • most common motor disorder of the esophagus and results from decreased lower esophageal spincter pressure allowing reflux to occur
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143
Q

SS of GERD?

A
  • Heartburn, Regurgitation, retrosternal burning
  • dysphagia
  • chest pain, radiates into back, neck and arms (similar to MI)
  • Hoarseness
  • chronic, non-productive, irritating cough
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144
Q

What aggravates GERD?

A
  • large meals, bending forward, lying down
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145
Q

What Relieves GERD?

A
  • Antacids, coating agents, burping
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146
Q

What causes ulcers?

A
  • NSAIDs

- H. pylori

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147
Q

What aggravates a Duodenal ulcer?

A
  • is too much acid secretion
  • increased pain at night (when not eating)
  • epigastric pain, burning gnawing or hunger
  • usually 40
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148
Q

What relieves pain from a duodenal ulcer?

A
  • food relieves the pain = weight gain but pain reoccurs 2-4 hrs after eating
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149
Q

What aggravates gastric ulcer?

A
  • hypo acid secretion

- food increases the pain = weight loss

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150
Q

What is a hiatus hernia?

A
  • protrusion of stomach above the diaphragm
  • sliding = gastroesophageal junction above diaphragm
  • paraesophageal = only a portion of the stomach above the diaphragm
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151
Q

SS of hiatus hernia?

A
  • asymptomatic
  • increased chest pain
  • heart burn, regurgitation with bending forward
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152
Q

Complications of a hiatus hernia?

A
  • stragulation, adenocarcinoma
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153
Q

What is a pancoast Tumor?

A
  • tumor within the superior pulmonary sulcus
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154
Q

What is pancosst syndrome?

A
  • 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
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155
Q

What does an xray of a pancoast tumor show?

A
  • pleural thickening in the apex of the lung
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156
Q

What causes pleuritis?

A
  • entry of infectious agent, irritating substance or neoplastic cells into pleural space
  • trauma or pleural disease can also cause problems
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157
Q

SS of pleuritis?

A
  • 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`
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158
Q

What is pneumonia?

A
  • inflammation and consolidation of lung tissue like the parenchyma, alveolar spaces and interstitial tissue
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159
Q

What does S. pneumoniae (pneumococcus) cause?

A
  • 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
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160
Q

What is the atypical cause of pneumonia?

A
  • Mycoplasma
  • in ages 5 to 35
  • like the flu
  • patchy consolidation
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161
Q

What are the stages of Lobar pneumonia (s. pneumoniae)?

A
  • consolidation
  • red hepatisation
  • resolution (CRGR)
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162
Q

What are other causes of pneumonia?

A
  • staph aureus

this affects mostly the eldery and is patchy consolidation like the pneumonia caused by myoplasma

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163
Q

SS of Lobar pneumonia (S. pneumoniae)?

A
  • rusty sputum
  • productive cough
  • HA, fever, chills
  • pleurisy (chest pain with coughing)
  • crackles, bronchial breathe sounds = signs of consolidation
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164
Q

Sputum color of mycoplasma pneumonia?

A
  • green
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165
Q

Sputum color of klebsiella?

A
  • currant jelly
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166
Q

What is the most common cause of AIDS?

A
  • pneumocystitis carinii
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167
Q

Cause of Pulmonary embolism?

A
  • DVT
  • fat embolism after fracture
  • air when diving
  • pregnancy
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168
Q

SS of pulmonary embolism?

A
  • 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
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169
Q

What ribs are most likely to fracture?

A
  • ribs 4 -10

- posterolateral convexity

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170
Q

SS of rib fracture?

A
  • 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
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171
Q

What will xray show in a rib fracture?

A
  • fracture line
  • cortical offset
  • callus formation (occurs within 10 to 14 days)
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172
Q

SS of rib subluxation?

A
  • 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
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173
Q

What aggravated a rib subluxation?

A
  • rotation
  • lateral bending
  • reaching or carrying loads on shoulder, deep breathing
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174
Q

What causes shingles?

A
  • Herpes varicella zoster

- latent chicken pox in the posterior root ganglion

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175
Q

SS of shingles 2 to 3 days before shingles appear?

A
  • 2 to 3 days before rashes appear
  • > pain, tingling or burning in involved dermatome
  • > fatigue, malaise, HA, low-grade fever
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176
Q

SS of shingles?

A
  • 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
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177
Q

How long do shingles take to recover?

A
  • 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
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178
Q

What are red flags of shingles?

A
  • 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

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179
Q

Cause of sternal fracture?

A
  • motor vehicle accident
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180
Q

SS of sternal fracture?

A
  • local pain over sternum
  • ecchymosis
  • dyspnea or pain on inspiration or deep breathing
  • palpable defect or crepitus
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181
Q

Cause of sternoclavicular joint dislocation?

A
  • FOOSH injury

- anterior dislocation is most common

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182
Q

SS of SC joint dislocation?

A
  • pain with arm motion
  • pain with compression against affect shoulder
  • medial clavicle protrusion
  • anterior/inferior displacement of shoulder
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183
Q

Risks of SCJ dislocation?

A
  • posterior dislocation can compress the trachea, subclavian vessels or brachial plexus
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184
Q

What is endocarditis?

A
  • inflammatory process of structures in heart caused by infective organisms
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185
Q

Causes of subacute endocarditis?

A
  • 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
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186
Q

SS of subacute Endocarditis?

A
  • 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
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187
Q

Cause of Acute endocarditis?

A
  • staph aureus
  • strep pneumoniae
  • N. gonorrhea
  • mostly affects heart valves that are normal and abnormal
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188
Q

SS of Acute endocarditis?

A
  • absence of heart murmur
  • high fever, rigors, sweating, leukocytosis
  • fatal within a few days or weeks if untreated
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189
Q

What is primary dysmenorrhea?

A
  • cyclic pain associate with ovulatory cycle; begins in adolescence and decreases with ages
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190
Q

What is secondary dysmenorrhea?

A
  • endometriosis = benign endometrial tissue growth grows outside uterine cavity
  • PID, leiomyoma, IUD
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191
Q

SS of Dysmonorrhea?

A
  • lower abdominal cramping
  • dull constant pain in low back, begins with menses
  • HA, nausea, constipation, disrrhea
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192
Q

What does lytic mets cause?

A
  • increase in serum Ca+
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193
Q

What does blastic mets cause?

A
  • increased serum ALP
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194
Q

Define obesity?

A
  • > 30% more than ideal weight`
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195
Q

What is BMI

A
  • weight/height
  • <18.45 is underweight
  • 18.5 to 24.9 normal
  • 25 - 29.9 overweight
  • 30 - 39.9 obese
  • > 40 morbidly obese
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196
Q

What is prostatitis?

A
  • inflammation or infection of the prostate
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197
Q

SS of prostatitis?

A
  • UTI
  • urinary frequency/urgency, dysurea
  • LBP or perineal
  • chills, fever
  • urethral discharge
  • enlarged, boggy, tender prostate
  • leukocytosis
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198
Q

Causes of urinary tract infection?

A
  • e.coli
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199
Q

Cause of urethritis?

A
  • Gonorrhea

- Chlamydia

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200
Q

SS of urethritis?

A
  • gradual onset
  • purulent discharge
  • dysuria, pyruia, frequency
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201
Q

Cause of Cystitis?

A
  • E. coli
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202
Q

SS of Cystitis?

A
  • sudden onset
  • Frequency, urgency, burning, painful voiding
  • no discharge
  • suprapubic pain
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203
Q

SS of Pyelonephritis?

A
  • rapid onset
  • chills, fever, flank pain, nausea, vomiting
  • costovertebral tenderness
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204
Q

What are the types of Claudication?

A
  • Neurogenic

- vascular

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205
Q

SS of neurogenic claudication?

A
  • pain with walking and standing
  • relieved by flexion
  • normal pulses
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206
Q

SS of vascular claudication?

A
  • pain with walking
  • relieved with rest and standing
  • not relieved with flexion
  • decreased pulses and skin changes
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207
Q

What creates myelin sheath in the CNS?

A
  • oligodendrocytes
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208
Q

What creates myelin sheath in the PNS?

A
  • schwann cells
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209
Q

What is myopia?

A
  • nearsighted

- can see objects which are close well but objects which are far are blurry

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210
Q

What is hyperopia?

A
  • farsighted

- can see objects far away but not close

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211
Q

What is encephalitis?

A
  • swelling of the brain
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212
Q

Cause of encephalitis?

A
  • viral:
  • arbovirus
  • polio
  • echo
  • herpes
  • varicella
  • mumps
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213
Q

SS of encephalitis?

A
  • fever, malaise
  • meningeal signs
  • HA, vomiting, stiff neck and back
  • altered consciousness, personality change, seizure, CN abnormalities
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214
Q

SS of joint fixation?

A
  • pain with active movemnt
  • relief with rest
  • achy, dull pain
  • decreased ROM
  • compression of the joint reduces pain
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215
Q

What is lateral epicondylitis?

A
  • partial/full tear of the extensor carpi radialis brevis
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216
Q

Cause of lateral epicondylitis?

A
  • repetitive motion: wrist extension, radial deviation, supination
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217
Q

SS of lateral epicondylitis?

A
  • 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
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218
Q

What is medial epicondylitis?

A
  • common flexor tendon pain
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219
Q

Cause of medial epicondylitis?

A
  • overuse
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220
Q

SS of medial epicondylitis?

A
  • gradual onset of medial elbow pain
  • pain with activity and relieved with rest
  • pain with active/passive elbow flexion and pronation
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221
Q

Where does median nerve (C5 - T1 lateral cord) entrapment occur?

A
  • axilla
  • bicipital aponeurosis
  • intercondylar ridge
  • ligament of struthers
  • pronator teres
  • flexor digitorum
  • superficialis
  • carpal tunnel
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222
Q

SS of Pronator teres syndrome?

A
  • anterior forearm pain
  • Hx of repetitive pronation and wrist flexion
  • pain with resisted pronation with elbow extended
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223
Q

SS of bicipital median nerve compression?

A
  • pain with resisted supination with elbow flexion
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224
Q

SS of Flexor digitorum superficialis median nerve compression?

A
  • pain with resisted middle finger flexion
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225
Q

SS of anterior interosseous syndrome (median nerve compression)?

A
  • 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
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226
Q

SS of carpal tunnel?

A
  • prolonged extension, pregnancy, RA, vitamin B deficiency

- pain numbness and tingling in the palmar thumb and the 3 radial fingers

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227
Q

What is ape hand?

A
  • cannot oppose/ abduct hand
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228
Q

Where does radial nerve ( C5 - T1) entrapment occur?

A
  • axilla
  • spinal groove
  • arcade of froshe
  • supinator
  • brachioradialis
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229
Q

SS of posterior interosseous nerve syndome?

A
  • 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
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230
Q

Test for Radial Nerve entrapment?

A
  • resisted middle finger extension test
  • resisted thumb extension (extensor policis longus)
  • wrist drop also occurs
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231
Q

Where does the ulnar nerve (C8 - T1 medial cord) entrapment occur?

A
  • axilla
  • flexor carpi ulnaris
  • cubital tunnel
  • guyons canal
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232
Q

SS of ulnar nerve entrapment?

A
  • claw hand 4 - 5th PIP/DIP flexion
  • less of thumb adduction
  • loss of abduction/adduction in the finger
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233
Q

What is a Baker’s Cyst (popliteal cyst)?

A
  • fluid dissension of gastoc-semimebranosis bursa
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234
Q

Cause of baker’s cyst?

A
  • osteo arthritis

- charcot joint

235
Q

SS of backer’s cyst?

A
  • posterior knee pain
  • decreased flexion
  • difficulty straightening after seated
  • popliteal mass
236
Q

What is chondromalacia patella?

A
  • 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
Q

SS of fibular head fixation?

A
  • sudden dorsiflexion or plantarflexion = pain
  • sudden onset of lateral knee pain
  • increased pain with hamstring curls
  • may irritate the common peroneal nerve
238
Q

What is De’Quervians Syndrome?

A
  • tenosynovitis of abductor pollicus longus and extensor pollicus brevis
239
Q

Cause of De’Quervians syndrome?

A
  • 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
Q

What is a lumbosacral strain?sprain?

A
  • damge to ligament or muscle in the lumbosacral region
241
Q

What is a grade 1 lumbosacral strain?

A
  • 1 - 10% damage to fibres
  • minimal pain
  • trigger points
  • decreased ROM
  • heals in 1 to 4 weeks
242
Q

What is a grade 2 lumbosacral sprain/strain?

A
  • 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
Q

What is a grade 3 sprain/strain?

A
  • 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
Q

Cause of the avulsion fracture of the ASIS?

A
  • sartorius muscles pulls off a piece of the ASIS in a young athele
245
Q

SS of an avulsion fracture of the ASIS?

A
  • sudden onset of acute pain w/ local swelling
  • POP sound
  • increased pain with hip and trunk movement especially in abduction and flexion
246
Q

SS of bursitis?

A
  • pain in all AROM
  • swollen and hot
  • pain with isometric testing
  • night pain
247
Q

Cause of Olecranon bursitis?

A
  • gout

- increased weight bearing on elbows

248
Q

SS of olecranon bursitis?

A
  • distal olecranon swelling
  • local pain and tenderness
  • increased pain at max extension or flexion
  • increased pain with resisted tricep extension
249
Q

Location of pes anserine bursitis?

A
  • sartorius muscle
  • grailis muscle
  • semitendinosis muscle
  • inserts superficial to the MCL
250
Q

SS of pes anserine bursitis?

A
  • 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
Q

SS of subacromial bursitis?

A
  • 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
Q

Most common location of plica syndrome?

A
  • mediopatellar
253
Q

SS of plica syndrome?

A
  • 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
Q

Cause of posterior hip dislocation?

A
  • MVA
  • occurs in the posterior 70 - 80%
  • mechanism of injury: hip flexed, adducted and internally rotated
255
Q

Cause of anterior hip dislocation?

A
  • MVA

- mechanism of injury: hip flexed, abducted and externally rotated

256
Q

SS hip dislocation?

A
  • severe pain in the hip and upper leg
  • inability to weight bear
  • posterior- affected limb is shortened, internally rotated and adducted
257
Q

Cause of ITB syndrome?

A
  • overuse with running, running downhill or any flexion at 30 - 40 degrees
258
Q

SS of ITB syndrome?

A
  • 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
Q

What is an inguinal hernia?

A
  • 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
Q

What is a direct hernia?

A
  • weakness in the floor of the inguinal canal

- mostly in people above the age of 40

261
Q

What is a indirect hernia?

A
  • passes through internal inguinal ring = most common
262
Q

SS of inguinal hernia?

A
  • lump or pain in the groin

- partial or complete blockage of the intestines this increases the risk of strangulation

263
Q

What is juvenile rheumatoid arthritis?

A
  • an autoimmune disorder
  • begins before the age of 16**
  • greater than one joint must be affected for greater than 6 months
264
Q

What are the types of juvenile rheumatoid arthritis?

A
  • Still’s disease
  • Pauciarticular
  • Polyarticular
265
Q

SS of Still’s Disease?

A
  • systemic onset
  • one joint affected
  • high fever, rash, splenomegaly
  • RF and ANA (antinuclear antibodies) absent
266
Q

SS of pauciarticular juvenile rheumatoid arthritis?

A
  • less than 4 joints
  • young girls (1 to 5)
  • large joints, eye changes
  • ANA (antinuclear antibodies) present
267
Q

SS of Polyarticular juvenile rheumatoid arthritis?

A
  • greater than 5 joints
  • symmetric and affects small joints
  • negative rheumatoid factor
268
Q

What is poliomyelitis?

A
  • polio virus causes lesions in the anterior horn and gray matter of the brain and spinal cord
269
Q

SS of minor Polio?

A
  • slight fever, HA, stiff neck, sore throat, vomiting

- self-limiting in 24 to 72 hours

270
Q

SS of major polio?

A
  • fever, severe HA, stiff neck and back
  • deep muscle pain, decreased dtrs flacid weakness, asymetrical muscle atrophy
  • no sensroy loss
  • progressive
271
Q

What is the salk vaccine?

A
  • inactivated polio vaccine
272
Q

What is the sabine vaccine?

A
  • live attenuated vaccine
273
Q

Cause of rheumatic fever w/ monoarthritis of the hip?

A
  • RF casued by S. pyogenes (group A streptococcus
  • in children from 6 - 15 years
  • previous strep infection
274
Q

SS of RF w/ monoarthritis of the hip?

A
  • tenderness and inflammation of the hip
  • fever
  • chorea
  • subcutaneous nodules
  • erythema marginatum
  • carditis
  • asciff bodies *** alwasy occur in RF
275
Q

What is cholescystitis?

A
  • inflammation of the gall bladder wall
276
Q

Cause of cholescystitis?

A
  • most commonly caused by gall stones
277
Q

SS of Cholecystitis?

A
  • 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
Q

Demographics of Choleslithiasis?

A
  • female
  • fat
  • 40
  • flatulence
279
Q

SS of choleslithiasis?

A
  • 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
Q

Imaging for cholelithiasis?

A
  • ultrasound
281
Q

Cause of pancreatitis?

A
  • gall stones

- alcohol

282
Q

SS of pancreatitis?

A
  • 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
Q

Lab results of pancreatitis?

A
  • increase serum amylase***
  • increase WBC
  • decreased Calcium and albumin
284
Q

What is chronic fatigue syndrome?

A
  • 6 months of persistent fatigue and cognitive difficulties

- 20s - 40s

285
Q

SS of chronic fatigue syndrome?

A
  • fatigue, short term memory impairment, sore thorat, tender lymph nodes, chest pain an palpitations, HA, depression, mood swings
286
Q

SS of Retroesophageal Hematoma?

A
  • the retropharygheal space is <7mm @ C3

- the retrotracheal space is < 22mm @ C6

287
Q

Cause of retroesophageal hematoma?

A
  • most commonly an injured longus colli
288
Q

Cause of bicipital tendonitis?

A
  • repeated throwing or overhead work
289
Q

SS of bicipital tendonitis?

A
  • increased pain with flexion and hyperextension
  • positive Yergasons, speeds and hyperextension test
  • popping with flexion, abduction and external rotation
290
Q

What is osgoode-schlatters disease?

A
  • 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
Q

Causes of osgoode-schlatters?

A
  • repeated traction by quads

- commonly occurs in kicking sports

292
Q

Osteoarthritis demographics?

A
  • patient > 45
293
Q

What are herberdens nodes?

A
  • degradation which occurs at the DIPS in Osteoarthritis
294
Q

What are bouchards nodes?

A
  • degradation which occurs at the PIPs in osteoarthritis
295
Q

What xray finding occurs in both RA or erosive RA?

A
  • MCP involvement
296
Q

SS of osteoarthritis?

A
  • morning stiffness for < 30mins, this improves with activity
  • decreased ROM, crepitus, enlarged painful joints
297
Q

Xray findings of osteoarthritis?

A
  • subchondral sclerosis
  • asymmetrical loss of joint space
  • subchondral cysts
  • vacuum phenomenon
  • osteophytes
298
Q

Xray findings of erosive osteoarthritis?

A
  • PIPs and DIPs have degradation

- gull wing erosions of DIPs and PIPs

299
Q

SS of erosive arthritis?

A
  • warm, swollen joints

- some foods increase swelling

300
Q

Cause of patellar tendonitis (jumpers knee)?

A
  • repetitive activity

- jumping/spiriting

301
Q

SS of Patellar tendonitis (jumpers knee)?

A
  • patella tracking problem
  • positive movie-goers sign
  • pain on resisted extension
302
Q

What is Patellofemoral pain syndrome?

A
  • patella tracking problem because of weak Vastus medialis oblique or weak medial/lateral retinaculum
  • pain caused by irritation of the fat pad
303
Q

SS of patellofemoral pain syndrome?

A
  • 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
Q

What is Popliteal tendonitis?

A
  • inflammation of the popliteal tendon

- pain infront of the LCL where it inserts upon non weight bearing rotation of the knee

305
Q

SS of politeal tendonitis?

A
  • pain with resisted internal rotation at 30 degrees

- lateral knee pain, specifically over insertion

306
Q

Popliteal muscle function?

A
  • pulls posterior-lateral meniscus posterior during knee flexion
307
Q

Cause of AC joint sprain?

A
  • direct or indirect trauma ex. FOOSH
308
Q

SS of AC sprain?

A
  • pain with passive abduction from 90 - 190 degress
  • clavicle also rotates with passive abduction
  • pain with passive horizontal adduction
309
Q

What is a grade 1 AC joint sprain?

A
  • AC ligaments small tear

- still have full ROM

310
Q

What is a grade 2 AC joint sprain?

A
  • AC ligament completely torn
  • coracoclavicular ligament intact
  • slight step off of the clavicle in xray
311
Q

What is a grade 3 AC joint sprain?

A
  • AC ligament completely torn
  • coracoclavicular ligament completely torn
  • greater joint separation and larger clavicle step off
312
Q

Most common spot for a clavicle fracture?

A
  • in the lateral 1/3 and the middle
313
Q

Demographics of adhesive capsulitis?

A
  • women
  • 40 - 65
  • diabetes
  • depression
314
Q

SS of adhesive capsulitis?

A
  • decreased ROM
  • capsular pattern = external rotation and abduction
  • hard end feel
  • takes 2 yrs to completely recover
315
Q

SS of stage 1 adhesive capsulitis?

A
  • called pre adhesive stage
  • minimal or no decreased in the ROM
  • painful abduction and external rotation
316
Q

SS of stage 2 adhesive capsulitis?

A
  • acute adhesive synovitis
  • painful arc of abduction
  • slight decreased ROM
  • constant pain and muscle atrophy
317
Q

SS of stage 3 adhesive capsulitis?

A
  • extreme loss of ROM then gradual improvement
318
Q

Most common shoulder dislocation?

A
  • anteriorly

- occurs with excessive abduction and external rotation

319
Q

SS shoulder dislocation?

A
  • positive apprehension test, relocation test, jobes test

- torn labrum can be associate with any GH dislocation

320
Q

Entrapment sites of supraclavicular nerve?

A
  • posterior aspect of the SCM

- beneath platysma

321
Q

Where does the supraclavicular nerve originate?

A

C3 C4 from the cervical plexus

322
Q

SS of supraclavicular entrapment?

A
  • pain in the anterior-superior shoulder thus a diffuse ache/pain in this area
323
Q

Cause of Supraspinatus tendonitis?

A
  • occurs because large eccentric load
324
Q

SS of supraspinatus tendonitis?

A
  • pain and weakness with shoulder abduction and external/internal rotation at 90 degrees
  • positive neers (subacromial impingement), empty can and Hawkins Kennedy
325
Q

Cause of shoulder impingement?

A
  • repetitive overhead work/activity
326
Q

SS of shoulder impingement?

A
  • 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
Q

SS of costovertebral subluxation?

A
  • 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
Q

SS Metacarpal fracture?

A
  • pain and swellin

- pain with vibration

329
Q

Cause of achilles tendonitis?

A
  • increased running and jumping

- trauma with forced dorsiflexion

330
Q

SS of achilles tendonitis?

A
  • 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
Q

Treatment of Achilles Tendonitis?

A
  • rest and ice

- refer to MD for NSAIDS

332
Q

Cause of anterior talo-fibular ligament sprain?

A
  • 85% ankle sprains = inversion

- too much inversion = sprain

333
Q

SS of grade 1 anterior talo-fibular sprain?

A
  • no tear
  • slight ROM decrease
  • slight pain
  • min swelling
  • usually no bruising
  • can fully weight bear
334
Q

SS of grade 2 anterior talo-fibular sprain?

A
  • partial tear (10-50%)
  • moderate loss of ROM
  • severe pain
  • moderate swelling
  • bruising
  • somewhat difficult to weight bear
335
Q

SS of grade 3 anterior talo-fibular sprain?

A
  • 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
Q

Treatment of grade 1 anterior talo-fibular sprain?

A
  • rest ice and co-mange
337
Q

Treatment of grade 2 anterior talo-fibular sprain?

A
  • rest ice and co-mange
338
Q

Treatment of grade 3 anterior talo-fibular sprain?

A
  • refer to an ortho
339
Q

Orthopeadeic tests used to diagnose anterior talo-fibular sprain?

A
  • anterior drawer

- talar tilt

340
Q

X-ray Ottawa Ankle Rules?

A
  • 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
Q

X-ray ottawa foot rules?

A
  • bone tenderness at the base of the 5th metatarsal
  • bone tenderness at the navicular bone
  • inability to weight bear or walk 4 steps
342
Q

Causes of a calcaneal bone spur?

A
  • ossification and calcification resulting from traction of the plantar fascia on the periosteum of the calcaneous (inferior surface)
  • increased standing, running, walking, obesity
343
Q

Where do calcaneal bone spurs most commonly occur?

A
  • medial calcaneal tuberosity where the plantar fascia attaches
344
Q

What can be related to bone spur?

A
  • reiter’s disease (reactive arthritis), AS, DISH
345
Q

SS of Calcaneal bone spur?

A
  • 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
Q

Xray finding of a calcaneal bone spur?

A
  • lateral bone spur
347
Q

Treatment for a calcaneal bone spur?

A
  • heel lifts
  • donut shoe inserts
  • straussverg sock
  • calf stretching
  • night splinting
  • shockwave
    can comanage with an ortho
348
Q

What is Charcot joints?

A
  • 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
Q

Underlying conditions associated with Charcot’s joints?

A
  • Diabetes mellitus (in foot)
  • syphilis ( in hip and knee)
  • syringomyelia (elbow knee and shoulder)
350
Q

Where does Charcots joints most commonly occur?

A

Knee

351
Q

SS of Charcot’s joints?

A
  • 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
Q

Xray findings of Charcot’s joints?

A
  • Hyper trophic
  • 6 D’s:
  • > distension
  • > increased density
  • > debris
  • > disorganization
  • > dislocation
  • > dislocation
  • > destruction
  • most pronounced hypertrophic weight bearing joints
353
Q

Demographics of Type 1 Diabetes Mellitus?

A
  • Insulin dependent
  • occurs at any age
  • usually in childhood or adolescent <30
354
Q

Causes of diabetes Mellitus type 1?

A
  • autoimmune

- insulin dependent because there is destruction of the beta cells in the pancreas

355
Q

Risks of Type 1 Diabetes?

A
  • diabetic ketoacidosis

- kussmaul breathing

356
Q

SS of Diabetic Mellitus Type 1?

A
  • polyuria
  • polydipsia
  • weight loss
  • bilateral peripheral neuropathy (stocking glove)
  • diplopia, fatigue, nausea
  • KID- restless, irritable, bed wetting, weakness, food cravings, polydipsia
357
Q

Diagnostic tests for Diabetes Mellitus Type 1 and Type 2?

A
  • fasting glucose is > 140 mg/dL (>7.7 mol/L)

- gold standard = glycosylated Hb

358
Q

Demographics of Diabetes Mellitus Type 2?

A
  • non-insulin dependent
  • > 30 years
  • most common in obese people
359
Q

Cause of diabetes mellitus type 2?

A
  • little insulin secreted from pancreas or the insulin receptors are not functional
360
Q

SS of diabetes mellitus type 2?

A
  • women have candidiasis (fungal growth in genital ex. yeast infection)
  • arteriosclerosis
  • infection
  • diabetic retinopathy
  • stocking - glove distribution of numbness and tingling
  • ulcers
361
Q

Treatment for Diabetes Mellitus Type 2?

A
  • weight loss
  • diet
  • education
362
Q

What is Gout?

A
  • monosodium urate crystal deposition in joints
363
Q

Demographics of a Gout patient?

A
  • male > 40
364
Q

What is hyperuricemia?

A
  • 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
Q

Causes of gout?

A
  • fatigue
  • surgery
  • trauma
  • emotional stress
  • increased purine because tomato, meat or spinach
366
Q

SS of gout?

A
  • 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
Q

Xray findings of gout?

A
  • 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
Q

Diagnostic tests for gout?

A
  • increased serum urate > 7mg in blood work

- needle shaped urate crystals in joint fluid or engulfed by phagocytes in culture

369
Q

Treatment for Gout?

A
  • refer to MD, colchicine, allopurinol,

- co-manage: weight loss, diet, education, tart cherry juice

370
Q

Risks associated with gout?

A
  • hypertension

- kidney disease/stones

371
Q

Differentials for gout?

A
  • CPPD

- RA

372
Q

Cause of Hallux Rigidus/Limitus?

A
  • biomechanics = limitation of ROM in big toe

- genetics

373
Q

SS of Hallux Rigidus?

A
  • pain/swelling/synovitis of joint
  • pain with extension of big toe or restricted dorsiflexion of big toe
  • bunion, hallux valgus
374
Q

Differentials of Hallux Rigidus?

A
  • metatarsalgia
  • sesamoiditis
  • arthritis
  • neuritis/neuroma
  • ulceration
  • tendonitis
375
Q

Xray finding of Hallux Rigidus?

A
  • arthritic changes in the 1st MTP joint
376
Q

What is hallux valgus?

A
  • lateral deviation of the first MTP joint
377
Q

Cause of hallux valgus?

A
  • OA
  • over-pronation
  • tight shoes
  • trauma
378
Q

SS of hallux valgus?

A
  • bunion
  • pain at 1st MTP joint
  • lateral deviation of 1st ray
  • increased dorsiflexion of distal phalanx
379
Q

Treatment of hallux valgus?

A
  • traction
  • orthotics
  • co-manage: NSAIDs, surgery
380
Q

What is Morton’s Neuroma?

A
  • neuroma (persistent thickening of perineurium) of the interdigital nerve
  • occurs more in W than M
381
Q

Where does Morton’s Neuroma most commonly occur?

A
  • between 3rd and 4th digits

- 3rd plantar interdigital nerve is a branch of medial and lateral plantar nerves

382
Q

Cause of Morton’s Neuroma?

A
  • poor shoe support

- trauma

383
Q

SS of Morton’s neuroma?

A
  • 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
Q

Diagnostics of Morton’s neuroma?

A
  • forefoot squeeze (morton’s squeeze test)
385
Q

Treatment of Morton’s neuroma?

A
  • proper footwear

- refer to ortho: lidocaine, corticosteroids, surgery

386
Q

What is osteochondritis Dissecans?

A
  • 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
Q

Where does osteochondritis Dissecans most commonly occur?

A
  • in the knee
  • > specifically the lateral part of medial femoral condyle
  • adolescent or young adult
388
Q

SS of osteochondritis dissecans?

A
  • anteromedial joint line pain
  • swelling and intermittent locking
  • crepitus and catching
389
Q

Diagnostics of osteochondritis dissecans?

A
  • positive wilsons test
390
Q

Xray findings of osteochondritis dissecans?

A
  • fragmentation
  • scalloped lateral aspect of medial femoral condyle or talar dome
  • joint mice is also possible
391
Q

What is Osteoid Osteoma?

A
  • painful benign overgrowth in long bones

- occurs in people from 10 - 25 years old

392
Q

SS of osteoid osteoma?

A
  • pain, worse at night

- relieved by aspirin

393
Q

Xray findings of osteoid osteoma?

A
  • 1cm of lucency surrounded by sclerosis = nidus

- cloud like shape with a white dot on the inside

394
Q

Differentials of Osteoid Osteoma?

A
  • brodie’s abscess results from an infection
395
Q

Causes of Raynaud’s disease?

A
  • idiopathic
  • in young women
  • ass. w/ migranes, variant angina, pulmonary hypertension
396
Q

What is raynaud’s disease?

A
  • 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
Q

What is Raynaud’s Phenomenon?

A
  • secondary raynaud’s usually because of an obstruction

- similar to raynaud’s disease but decreased BP in digital arteries at rest

398
Q

What is raynaud’s phenomenon associated with?

A
  • 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
Q

SS of Raynaud’s phenomenon?

A
  • 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
Q

How to diff Raynauds disease from Raynauds phenomenon?

A
  • 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
Q

Treatment of Raynaud’s?

A
  • stop smoking
  • protect body from warm/cold extremes
  • sedatives for stress/relaxation techniques
  • calcium channel blockers
  • sympathectomy
402
Q

What is reiter’s syndrome?

A
  • arthritis after GU or GI infection
403
Q

SS of Reiter’s syndrome?

A
  • 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
Q

Most common cause of Reiter’s syndrome?

A
  • chlamydia trachmatis

- in men in 20-40

405
Q

Diagnostic results of Reiter’ syndrome?

A
  • negative rheumatoid factor

- positive HLA-B27

406
Q

Xray results of Reiter’s syndrome?

A
  • 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
Q

Treatment for Reiter’s syndrome?

A
  • refer to MD for tetracycline

- do not adjust during the inflammatory page

408
Q

What is Rheumatoid Arthritis?

A
  • systemic autoimmune disease targeting synovial tissue
409
Q

Demographics of Rheumatoid Arthritis?

A
  • W>M

- 25 - 50 yrs

410
Q

SS of rheumatoid arthritis?

A
  • 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
Q

Diagnostics results of rheumatoid arthritis?

A
  • positive rheumatoid factor
  • increased ESR and CRP
  • mild anemia
412
Q

Xray findings of rheumatoid arthritis?

A
  • 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
Q

Xray finding of Rheumatoid Arthritis in the cervical spine?

A
  • dens erosions
  • lateral mass erosions
  • tapered SP
  • eroded/fused facets
  • disc space
  • ADI narrowing
  • protrusio acetabuli = otto’s oelvis
414
Q

Treatment of Rheumatoid Arthritis?

A
  • co-manage and refer to a rheumatologist
415
Q

Causes of septic arthritis?

A
  • bacterial: gonococcal = N. gonorrhea (gram negative)

- viral: parvovirus B19, hepatitis B and V rubella

416
Q

SS of septic arthritis?

A
  • acute, sudden onset of joint pain and swelling
  • moderate severe joint pain
  • warm tender and decreased ROM
  • general fatigue
417
Q

Diagnostic results for septic arthritis?

A
  • increased ESR
  • increased CRP
  • WBC > 20 000/uL
  • decreased protein
  • decreased glucose
  • during bacterial culture -> gram stain is red
418
Q

Xray findings of Septic Arthritis?

A
  • Lytic destruction on both bones of a joint
  • joint space will be different
  • monoarticular unless in the spine
419
Q

What is sever’s disease (calcaneal apophysitis)?

A
  • painful cartilage break in the calcaneus
420
Q

Cause of sever’s disease?

A
  • vigorous activity

- occurs mostly in ages 8 - 16 when the ossification centers are held together by interosseous ligament

421
Q

SS of sever’s disease?

A
  • heel pain with walking
  • limp
  • history of trauma or repetitive strain
  • warmth and swelling
  • xray is not helpful but may show heel spurs
422
Q

Treatment for sever’s disease?

A
  • heel lifts
  • stretch hamstrings/calves
  • RICE
  • NSAIDS
423
Q

Cause of Posteriolateral Talar Tubercle Fracture?

A
  • forced plantar flexion ex jumping in basketball

- talus hits the posterior-inferior lip if the tibia

424
Q

SS of Posteriolateral Talar Tubercle Fracture?

A
  • 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
Q

What is Tarsal Tunnel Syndrome?

A
  • compression of the posterior tibial nerve as it runs through the tarsal tunnel (medial ankle) and divides into medial and lateral plantar nerves
426
Q

Cause of Tarsal Tunnel Syndrome?

A
  • synovitis of Tibialis posterior, Flexor Digitorum longus, Flexor digitorum hallicus
  • inflammatory arthritis
  • edema
427
Q

SS of Tarsal Tunnel Syndrome?

A
  • 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
Q

Treatment of Tarsal Tunnel Syndrome?

A
  • tape foot or orthotics
  • inverts foot to tension nerve
  • NSAIDs
  • corticosteroids
  • surgery
429
Q

What are varicose veins?

A
  • dilated, tortuous superficial veins in the extremities, usually bilateral
430
Q

Causes of varicose veins?

A
  • primary: most commonly inherent weakness in the veins
  • secondary: pregnancy
  • prolonged standing does not cause varicose veins
431
Q

SS of varicose veins?

A
  • 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
Q

Treatment of varicose veins?

A
  • incurable

- can use compression stockings

433
Q

What is Venous Thrombosis (Thrombophlebitis)?

A
  • Virchow’s Triad = 1) injury to endothelium 2) Hypercoagulability 3) stasis
  • most commonly affects saphenous vein
434
Q

Causes of Venous Thrombosis (Thrombophlebitis)?

A
  • bedrest
  • pregnancy
  • inactivity
  • oral contraceptives
435
Q

What is Superficial Venous thrombosis?

A
  • pain, tenderness, erythema and warmth
  • palpable linear cord
  • requires referal
  • contraindication to massage over area but not a red flag
436
Q

What are the types of Deep Venous Thrombosis?

A
  • acute Iliofemoral Deep Vein Thrombosis

- acute DVT of the calf

437
Q

What is acute iliofemoral deep vein thrombosis?

A
  • dilated superficial collateral veins over the leg and lower abdomen
  • due to lack of drainage from the blocked vein
438
Q

SS of Acute Iliofemoral Deep Vein Thrombosis?

A
  • 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
Q

What is Acute DVT of calf?

A
  • 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
Q

SS of Acute DVT of calf?

A
  • 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
Q

What is Chronic venous insufficiency?

A
  • fullness, aching, tiredness in leg and swelling
442
Q

SS of chronic Venous insufficiency?

A
  • 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
Q

Treatment of Chronic venous insufficiency?

A
  • refer to MD

- heparin or other anti-coagulants

444
Q

Cause of facet syndrome?

A
  • irritation of capsule, facet and meniscoid

- innervated by medial branch of PPR from above an below

445
Q

SS of Facet Syndrome?

A
  • localized LBP, may refer into butt/thigh but does not pass knee
  • no neuro signs
  • positive kemps and SLR past 70 degrees
446
Q

Types of hypersensitivity reactions (allergies)?

A
  • Type 1
  • Type 2
  • Type 3
  • Type 4
447
Q

Type 1 hypersensitivity reaction?

A
  • 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
Q

Type 2 hypersensitivity reaction?

A
  • 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
Q

Type 3 hypersensitivity reaction?

A
  • 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
Q

Type 4 hypersensitivity?

A
  • cell mediated or delayed hypersensitivity

- ex. tuberculin (montoux) reaction which peaks 48 hrs after the injection of antigen = contact dermatitis

451
Q

Risk Factors of Bronchogenic Carcinoma?

A
  • smoking
  • occupational/environmental irritants
  • occurs in ages 45 - 70
452
Q

What are the types of Bronchogenic Carcinoma?

A
  • Squamous cell carcinoma (25 - 40%)
  • Small cell carcinoma (20 - 25%)
  • Adenocarcinoma (25 - 40 %)
  • Pancoast Tumor
453
Q

SS of bronchogenic carcinoma?

A
  • 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
Q

What is squamous cell carcinoma?

A
  • 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
Q

What is small cell carcinoma?

A
  • 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
Q

What is adenocarcinoma?

A
  • most common in women and non-smokers

- peripheral location, coin lesions (empty looking lesion)

457
Q

What is a pancoast tumor?

A
  • Horner’s syndrome:
  • > miosis
  • > ptosis
  • > anhydrosis
  • ulnar nerve distribution type symptoms
458
Q

What is scleroderma?

A
  • chronic autoimmune disease

- W>M

459
Q

SS of scleroderma?

A
  • fibrosis
  • degenerative changes
  • vascular abnormalities in skin and internal organs
460
Q

What is CREST syndrome?

A
  • limited cutaneous scleroderma
461
Q

SS of CREST syndrome?

A
  • Calcinosis
  • Raynauds phenomenon
  • esophageal dysfunction
  • sclerodactyly- skin becomes taught and skinny, hyperpigmented and face is mask like
  • telangiectasia
  • affects hands arms and face
462
Q

What is Diffuse systemic scleroderma?

A
  • 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
Q

Differentials of scleroderma?

A
  • thickened skin
  • raynauds
  • ANA antibodies
464
Q

What is Bromelain?

A
  • 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
Q

What is calcium needed for?

A
  • muscle contraction, nerve conduction, hormone release and blood coagulation
466
Q

Daily requirements of calcium?

A
  • 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
Q

What vitamin is required to absorb calcium?

A
  • vitamin D
468
Q

What is hypocalcemia?

A
  • < 8.8 mg/dL
  • muscle cramps
  • tetany
  • laryngospasm
  • generalized convulsions
  • long term:
  • > Rickets
  • > osteoporosis
469
Q

What is hypercalcemia?

A
  • usually b/c increased bone resorption
  • constipation
  • anorexia
  • nausea
  • vomiting
  • abdominal pain and ileus
470
Q

What is Cobalamin?

A
  • Vitamin B12
471
Q

Functions of Cobalamin?

A
  • humans are the only animal to require B12
  • required for methionine regeneration, converts homocystine to methionine
  • helps with DNA synthesis
  • RBC production
472
Q

Sources of Cobalamin?

A
  • only animal sources

- liver, kidney, milk

473
Q

SS of cobalamin (B12) deficiencies?

A
  • 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
Q

Diagnostics for cobalamin (B12) deficiency?

A
  • Schilling Test: tests for intrinsic factor
475
Q

What is Magnesium?

A
  • 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
Q

Functions of Magnesium?

A
  • 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
Q

RDI of Magnesium?

A
  • 250 - 320 mg/day
478
Q

Food sources of Magnesium?

A
  • nuts, legumes, unrefined grains, green veggies, milk, cheese, meat, seafood, hard water
479
Q

SS of Magnesium deficiency?

A
  • 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
Q

Functions of Chromium?

A
  • aids glucose, lipid and protein metabolism
481
Q

Sources of Chromium?

A
  • brewers yeast, peanuts, wine, apples
482
Q

SS of Chromium deficiency?

A
  • poor insulin function
  • glucose tolerance
  • elevated cholesterol
483
Q

What is Echineacea?

A
  • 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
Q

Adverse affects of Echinacea?

A
  • tiredness
  • somnolence
  • dizziness
  • headache
  • GIT disturbance
  • eczema
  • immunosupression w/ prolonged use
485
Q

What is fibre?

A
  • undigestible complex of CHO found in plants
486
Q

What is water soluble fiber?

A
  • 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
Q

What is water insoluble fiber?

A
  • 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
Q

What is folic acid (B9)?

A
  • water soluble B-Vitamin
489
Q

Sources of Folic Acid (B9)?

A
  • broccoli, spinach, orange

- fortified breads/grains

490
Q

SS of Folic Acid (B9) deficiency?

A
  • lack of B9 in first trimester can cause spina bifida and other congenital deformities
  • anemia
  • glossitis
  • depression
  • birth defects
491
Q

Function of Folic Acid (B9)?

A
  • protein synthesis
  • cell growth
  • fetal development (may protect against heart disease, cervical and colon cancer)
492
Q

What is Glucosamine/Chondroitin Sulfate?

A
  • proteoglycans of amino sugars are called glycosaminoglycans, they interact with collagen
  • commonly used in OA
493
Q

Contraindications to Glucosamine?

A
  • seafood allergy
  • active peptic ulcers
  • people on diuretics
494
Q

What is iron used in?

A
  • 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
Q

What is Malic Acid?

A
  • hydroxysuccinic acid

- comes from apples

496
Q

Function of Malic Acid?

A
  • deriving ATP from food
497
Q

What is Methylsulfonylmethane?

A
  • 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
Q

What is Thaiamine (B1)?

A
  • required in the form of TPP (thiamine pyrophosphate
499
Q

What enzyme require Thaiamine (B1) in order to function?

A
  • 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
Q

Function of Thiamine (B1)?

A
  • glucose oxidation/kreb’s
  • healthy functioning of nerve and brain cells
  • niacin synthesis
  • TPP helps with conversion of trypotophan to niacin
501
Q

What are the sources of Thiamine?

A
  • sunflower seeds
  • peanuts
  • wheat brain
  • beef
  • liver
  • pork
  • seafood
  • egg yolk
  • beans
502
Q

SS of Thiamine (B1) deficiency?

A
  • slow and unsteady gait
  • severe disturbances in posture, equilibrium, mental confusion and possible coma
  • wet beriberi
  • dry beriberi
  • infantile beriberi
503
Q

SS of wet BeriBeri?

A
  • heart dysfunction
  • symptoms on physical exertion
  • edema
  • numbness in legs
  • irritability
  • vague uneasiness, disorderly thinking
  • nausea
  • heart failure
  • death
504
Q

Treatment of Wet BeriBeri?

A
  • increase thiamine intake
505
Q

SS of Dry BeriBeri?

A
  • polyneuritic nerve dysfunction, bilateral and dysfunction
  • associated with low calorie diet and inactivity
  • numbness in toes/legs
  • irritability
  • vague uneasiness
  • disorderly thinking
  • nausea
506
Q

SS of Infantile BeriBeri?

A
  • affects the brain, nerves and heart
  • breast fed but poor in thiamine
  • first notice symptoms at 2 - 5 months
  • cyanosis
  • tachycardia
  • vomiting
  • convulsions
507
Q

Causes of Wernicke Koraskoff syndrome (cerebral BeriBeri)?

A
  • 3 factors: alcohol, poor diet, genetics

- these can impair thiamine absorption in jejunum and ileum

508
Q

SS of Wernicke Koraskoff syndrome (cerebral BeriBeri)?

A
  • mental confusion
  • loss of balacne
  • muscular incoordination
  • visual problems
  • coma
  • death
  • irreversible
509
Q

What is Riboflavin (B2)?

A
  • manufactured in the body by intestinal flora, easily absorbed as riboflavin, small amount stored
  • facilitated essential co-enzyme in dehydrogenase reactions
510
Q

What enzymes require Riboflavin (B2)?

A
  • essential in dehydrogenase reactions
  • enzymes requiring FMN or FAD
  • G3P dehydrogenase (Glucose to G3P)
  • Pyruvate dehydrogenase (Pyruvate to Acetyl to CoA)
511
Q

Functions of Riboflavin (B2)?

A
  • 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
Q

Sources of Riboflavin (B2)?

A
  • yeast, liver, organ meats, dairy products, whole or enriched grains
513
Q

SS of Riboflavin (B2) Deficiency?

A
  • 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
Q

Who is at risk of Riboflavin (B2) deficiency?

A
  • alcoholics: decreases Vitamin B2 absorption in the intestines
  • strict vegetarian diets- b/c low B2 availability
515
Q

Function of Niacin (B3)?

A
  • required for epithelial cell turnover
  • substrate for NAD used in dehydrogenase reactions (CHO, protein, fat metabolism)
  • sex hormone synthesis
516
Q

Sources of Niacin (B3)?

A
  • liver meat
  • poultry
  • legumes
  • nuts
  • milk
  • grain
  • fruits
517
Q

SS of Niacin Deficiency?

A
  • Pellagra: bilateral dermatitis, diarrhea, dementia, death

- CNS irritability, headache, sleepiness, loss of memory, hallucinations, severe depression

518
Q

Treatment of Niacin deficiency?

A
  • megavitamin therapy
  • treatment reduce cholesterol
  • Nicotinic acid can cause skin flushing
519
Q

Function of Pyridoxine (B6)?

A
  • TRANSAMINATION of amino acids
  • homocysteine metabolism
  • glycogen degradation
  • RBC and Hb synthesis
  • NT synthesis (GABA, NE, serotonin)
520
Q

SS of Pyridoxine (B6) deficiency?

A
  • 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
Q

Who is at risk for Pyridoxine (B6) deficiency?

A
  • at risk:
  • alcoholics
  • cirrhosis
  • consumption of oral contraceptives
522
Q

Function of Turmeric?

A
  • 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
Q

Sources of Vitamin A (retinol)?

A
  • fish
  • liver
  • egg yolk
  • butter
  • beta carotene in green vegetable is converted to retinol in the small intestines
524
Q

SS of vitamin A (retinol) deficiency?

A
  • growth retardation
  • night blindness
  • hazy dry cornea
525
Q

Function of Vitamin E?

A
  • antioxidant, formation of DNA/RNA and RBCs
526
Q

SS of Vitamin E deficiency?

A
  • mild haemolytic anemia
  • spinocerebellar disease (ataxia)
  • loss of DTRs with diminished vibratory and position sense
527
Q

Functions of Vitamin C?

A
  • collagen
  • wound healing
  • dentition
  • helps release free folic acid
  • helps with absorption of iron and copper
528
Q

SS of Vitamin C deficiency?

A
  • 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
Q

Functions of vitamin D?

A
  • increases Ca absorption
  • bone formation
  • mineralization
530
Q

Forms of Vitamin D?

A
  • D2 = Ergocolciferol is found in yeast

- D3 = cholecalciferol is found in human skin and is formed by U/V radiation exposure

531
Q

SS of Vitamin D Deficiency?

A
  • Rickett’s: soft bones, bowing, restless, poor sleep, frontal bossing, enlargement of epiphyseal cartilages, delayed walking
  • osteomalacia in adults: soft bones, pseudofractures, bowing
532
Q

What is the most common area affected by Vitamin D Deficiency?

A
  • most common area affected is distal radius and ulna with increased joint spaces between them
533
Q

Function of Vitamin K?

A
  • controls the formation of coagulation factors (within the liver)
  • requires calcium to work
534
Q

SS of Vitamin K deficiency?

A
  • 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
Q

What is Polyuria?

A

> 2000 mL/day

536
Q

What is Oliguria?

A

<500 mL/day

537
Q

What is Nocturia?

A

> 500 mL/day

- decreased specific gravity

538
Q

What is anuria?

A
  • no urine output
539
Q

What is normal urine excretion?

A
  • 750 to 1500 mL/day
540
Q

What is Hyponatremia?

A
  • Low sodium

- high h20

541
Q

Causes of Hyponatremia?

A
  • aldosterone deficiency

- diuretic therapy

542
Q

SS of Hyponatremia?

A
  • altered mental status
  • lethargy
  • confusion
  • stupor
  • neurovascular hyperexcitability
  • convulsion
  • coma
  • death
543
Q

What is Hypernatremia?

A
  • high sodium

- low H20

544
Q

Causes of Hypernatremia?

A
  • diabetes insipidus (decreased ADH, decreased urine)
  • increased sweating
  • vomiting
  • diarrhea
545
Q

SS of hypernatremia?

A
  • thirst
  • confusion
  • seizure
  • coma
  • thrombosis
546
Q

Sources of Zinc?

A
  • liver
  • eggs
  • seafood
547
Q

SS of Zinc deficiency?

A
  • 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
Q

Most common area for cervical disc herniation?

A
  • C5/C6
549
Q

Which spondyloarthopathies look the same on x-ray

A
  • Ankylosing Spondylosis and enteropathic arthritis

- specifically bilateral sacroiliitis

550
Q

Which IVFs do LAO and RPO cervical oblique xrays show?

A
  • Left IVF
551
Q

Which IVFs do RAO and LPO cervical obliques xrays show?

A
  • Right IVF
552
Q

Which IVFs are shown on anterior obliques?

A
  • IVF and pars on opposite side of marker

- ex. LAO = R IVF and pars

553
Q

Which IVFs are shown on posterior obliques?

A
  • IVF and pars on same side as marker

- ex. RPO = R IVF

554
Q

What is spondylitis?

A
  • inflammation of the vertebrae
555
Q

What is spondylosis?

A
  • degenerative OA of vertebrae
556
Q

What is spondylolisthesis?

A
  • break in the pars and slippage of the vertebrae
557
Q

What is Spondylolysis?

A
  • break in the pars
558
Q

Xray findings of whiplash associated disorder (WAD)?

A
  • interspinous widening
  • anterior slippage
  • intersegmental flexion of SP
559
Q

What is ALS?

A
  • autoimmune disease affecting people >50

- it is progressive and is caused by the degraation of motor neurons both UMN and LMN

560
Q

SS of ALS?

A
  • muscle weakness and atrophy
  • muscle fasciculations
  • slurred speach
  • hyperreflexia
  • positive babinskis sign
561
Q

What is Springomyelia?

A
  • a cyst that forms within the spinal cord
562
Q

SS of sprinomyelia?

A
  • 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
Q

What causes a HA in a child?

A
  • dehydration ins the most common cause

- but alos tension, rebound, migrane

564
Q

How does a child migrane differ from an adult migrane?

A
  • 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
Q

What does excess vitamin E cause?

A
  • GIT distree

- also causes supression of other antioxidants and increases the risk of heamorragic stroke

566
Q

Excess Vitamin D?

A
  • hypercalcemia

- constipation

567
Q

What mineral is least toxic to the body in excess?

A

-zinc

568
Q

What are the most toxic vitamins?

A
  • D (most likley to be taken in excess and E which has the most harmful effects
569
Q

Waht does Vitamin B6 deficiancy cause?

A
  • Dorsal Root Ganglion Degeneration
570
Q

SS of vitamin B6 deficiancy?

A
  • causes sensory peripheral neuropathy
571
Q

What causes subacute degradation of the spinal cord?

A
  • B12 deficiancy

- Thiamin- Beri Beri

572
Q

What innervates the sciatic nerve?

A
  • L4-S2

- nerve tensioning tests: SLR, well leg raise, braggards, bowstrings

573
Q

What does a high CHO diet cause?

A
  • salivary amylase begins breakdown in mouth
  • increased glucagon production
  • increased glucose -> increased insulin -> glucagon’s in tissue for storage
574
Q

Why do athletes not have as much lactic acid build up?

A
  • 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
Q

Contraindications to Heat Therapy?

A
  • acute injury
  • open wounds
  • neuropathy
  • Multiple myeloma
  • myositis ossificans
  • DVT
  • infection
  • circulatory problems
576
Q

What frequency does deep ultrasound use?

A
  • 1 Mz
577
Q

What frequency does superficial ultrasounduse?

A

3 Mz

578
Q

What type of ultra sound produces heat?

A
  • continuous
579
Q

What type of ultrasound does not produce heat?

A
  • pulsed
580
Q

Contrindications to ultrasound?

A
  • cancer
  • over eyes ears, gonads, brain and spinal cord
  • cancerous
  • pregnancy
  • over lung fields
  • TB
  • decreased sensation (risk of periosteal burns)
581
Q

Where is the most common location of osteosarcoma?

A
  • the knee
582
Q

Xray findings of an unstable compression fracture?

A
  • step defect, wedge deformity, linear zone of condensation, endplate displacemnt, paraspinal swelling, abnormal small bowl gas
  • decreased disc space
583
Q

Most common location of a unstable compression fractyure?

A
  • T12-L1

Part B Canadian Boards (9 decks)

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