EXAM 1- LBP Patho Flashcards
what is the normal pH function
7.35-7.45
kidneys remove acids and keep bases
lungs balance the acidic CO2
what is respiratory acidosis
hypoventilation and an accumulation of acidic CO2
what are the urinary S&S
pain in trunk, flank, pelvic region
discoloration
urinary changes
dysfunction
nocturia
what is in a urinary review
most from Hx
observation of urine- unlikely, ask
pain with kidney percussion
pain with bladder palpation/percussion
what are the functions of the urinary system
filter fluid from renal blood flow
stimulate RBC production
blood pressure regulation
convert vitamin D to active form
what is retained when filtering fluid in urinary system
electrolytes and acid/base balance
what are reproductive S&S
pain in pelvis, Lb, abdominal regions
dysfunction- sexual and bowel
abnormal discharge/menstruation
what are unknown pregnancy indications
polyuria
breast tenderness
fatigue
heartburn
constipation
what is in a review for the reproductive system
most from hx
observation unlikely
what is the function of metabolic system
conversion of foods and liquids into energy and building blocks
elimination of waste
fluid and electrolyte balance
why are metabolic S&S so varied
due to imbalance of electrolytes, fluid and pH balance
what are the most common causes of polyuria and/or dehydration
diabetes
kidney dysfunction
malignancy
alcohol
medication side affects
burns
diarrhea
N&V
describe sodium
maintains fluid volume and membrane potential between cells for messages to and from the CNS
what is the most frequent electrolyte disorder
hyponatremia- low sodium, neuro S&S
describe potassium
maintains fluid volume
what is hypokalemia
cardiac arrythmias
what is hyperkalemia
muscle dysfunction
describe calcium
involved with bone, muscle action, nerve impulses, circulation, and hormones
describe phosphorus
bones and teeth
crucial role in growth, maintenance, and repair of all tissues
describe bicarbonate
works as an acid buffer
diarrhea is the main loss of bicarbonate
describe magnesium
mainly involved in neuromuscular functions
describe chloride
regulates fluid in and out of cells
what are S&S of fluid and electrolyte imbalance
skin- loss of elasticity, temp
neuromuscular - fatigue, cramp, twitch
CNS- memory loss, depression, seizures
cardio- tachycardia, altered respirations
what can cause respiratory acidosis
disorders affecting respiration
drugs suppressing respiration - opiods/muscle relaxers
sleep apnea
what are S&S of respiratory acidosis
headache
anxiety
memory loss
sleep disturbance
incoordination/tremor
what is respiratory alkalosis
hyperventilation leading to loss of acidic CO2
what can cause respiratory alkalosis
pulmonary conditions
anxiety
anemia with less oxygenation
what are S&S of respiratory alkalosis
SOB
light headedness
what is metabolic acidosis
most common acid-base abnormality
accumulation of acidic H ions
what can cause metabolic acidosis
diabetes and the build up of ketones
diarrhea/dehydration
kidney disease
what are S&S of metabolic acidosis
long deep breath that is fruity
polyuria
dry mouth
excessive thirst
blurry vision
weakness/fatigue
what is metabolic alkalosis
accumulation of bicarbonate base
what can cause metabolic alkalosis
vomiting by loss of stomach acid
kidney disorders
excessive antacid
diarrhea
what are S&S of metabolic alkalosis
headache
neuromuscular- paresthesia, twitch, seizures
muscle alterations
what is in a metabolic review
hx
observation
resisted or manual m testing- weakness
neuro tests - altered sensation
abdominal assessment- liver, pancreas, kidney
standard vitals- tachycardia, RR, hypotension
palpation - loss of skin mobility, extreme skin temp
what can we observe in a metabolic review
muscle twitch
altered respiration
memory loss
incoordination
dry mouth
fruity breath
what are commons signs of infection
malaise
fever, chills, sweats
N&V
enlarged, tender lymph nodes
signs specific to the infected systems
what is different about the infection symptoms in an older individual
mentation changes
subnormal body temp
bradycardia or tachy
fatigue/lethargy
what is in a systems review for infection
hx
observation- redness, swelling
palpation- lymph nodes, heat, swelling
vitals- temp high
what are common S&S of the immune system
GI pain/dysfunction
muscle or joint pain
skin and weight changes
typically affecting more than 1 part of the body
emotional changes
what is in an immune system review
hx
observation- persistent swelling or pitting edma
high temperature
palpation of swollen and tender lymph nodes
what are cancer S&S
hx of cancer
P!- local and referred, especially at the same time at night (due to tumors metabolic activity), no change with position change
increased WBC with absence of infection
swollen and NON tender lymph nodes
what is in the cancer review
hx and observation
palpation of lymph nodes- NON tender
high temperature
what are the main functions of the cardiovascular system and primarily with what two other systems
respiratory and nervous
circulate oxygenated blood throughout body
circulate deoxygenated blood to lungs
what are common S&S of the cardiovascular system
hx of family heart attack prior to age 60
pain in chest with or without referred pain C4-T4, especially with exertion
heart palpitations
SOB/wheezing
what is in the cardiovascular review
hx
observation - SOB, wheezing, sweating
vitals- HR, RR, BP
ankle-brachial index
what are common S&S of respiratory system
pain in neck and upper shoulder
thorax pain
digital clubbing
SOB
decreased breath sounds
hyperresonance with percussion
what is in the respiratory review
hx
observation- cyanosis, digital clubbing, SOB
vitals- RR
decreased breath sounds
percussions
what are common S&S of the GI system
dysphagia
N&V
food eversion/intolerance
indigestion/heartburn
full feeling (bloated)
what is in a GI review
hx
observation - wavelike motion over intestines, difficulty swallowing
abdominal quadrant assessment
LMN vs UMN: increased or spastic muscle tone
UMN
LMN vs UMN: incontinence or leakage bladder
LMN
LMN vs UMN: hypoactive DTR
LMN
LMN vs UMN: multi-segmental diminished with dermatomes
UMN
LMN vs UMN: spastic or retentive bladder
UMN
LMN vs UMN: single segment muscle fatiguing weakness
LMN
LMN vs UMN: superficial reflex is hypoactive
UMN
what are the S&S of lumbar myelopathy
extreme spinal pain
multisegmental weakness/numbness
spastic or rententive bladder
dtr= hyperactive
UMN +
stress test +
what are the S&S of spinal malignancy
spinal pain- unfamiliar/severe
bony landmark alterations - fx
unable to lay flat
mechanical pain thats random
tenderness to palpation
how can spinal infection happen
develops 2-3 years after initial air droplet infection into lungs
lungs to vb to disc to adjacent vb
how does a spinal infection spread
lymph nodes and blood
what can happen if an abcsess grows in a spinal infection
nerve root irritation
vb collapse/fx
cord compression
what can happen if spinal infection goes untreated
neuro S&S influence LE coordination including bowel and bladder
what are the early S&S of spinal infection
age related changes like back pain and stiffness
how can spinal infection be shown on xray
body destruction
TB abscess
loss of height
sclerotic end plate
diminished disc space
what are the RF for a spinal infection
immunosuppression
surgery
IV drug use
social depravation
hx of TB
what are the S&S of spinal infection
localized and progressive pain that limits motion- flexion
mechanical pain
stress test + for disc
unexplained weight loss
TTP, percussion, vibration
what is osteomyelitis
bone infection
what is discitis
disc infection
where is the infection more common in lumbar region
the disc
what is cauda equina syndrome
compression of some degree of 20 sp nn that originate from the end of the spinal cord
what are the S&S of cauda equina syndrome
hx of LBP
bowel/bladder incontinence
sexual dysfunction
paresthesia/decreased sensation in multiple dermatomes
multiple myotome weakness
hypoactive DTR
+ dural mobility
what is the referral for cauda equina syndrome
emergency due to multiple spinal nn
what is ankylosing spondylitis
autoimmune disease
chronic inflammation at cartilage, tendon, ligament, and synovium attachments to bone
erosive osteopenia and bony overgrowth
leads to fusion of involved joints
what are S&S of spondyloarthritides
greater than 30 min of pain/stiffness after prolonged position
improved pain with easy and regular movements
chronic inflammation and pain of axial skeleton
genetics
hurts to see, pee, and bend my knees
what are the S&S of ankylosing spondylitis
progressive LBP and sacroiliac jt
less than 40 yrs
lasting more than 3 months
no change with rest
night pain from static position
buttock and hip pain
what can we observe with ankylosing spondylitis
hyperkyphosis
loss of lumbar lordosis
what can be found in a scan for ankylosing spondylitis
multiple direction of limited motion
combined motion= always limited
stress test with prolong hold is painful
what is the referral for ankylosing spondylitis
urgent referral for rheumatologist
what can be found in a biomechanical exam for ankylosing spondylitis
multiple direction hypomobile accessory motion
limited thorax excursion with manubrial and rib springs
how do we treat ankylosing spondylitis
be sensitive to trauma in patients
fall risk
gentle ROM and exercise considering fragile
postural education
what are complications for ankylosing spondylitis
osteoporosis
fractures
craniovertebral subluxations
stenosis
fusion in upright or more often forward bent position
extraarticular conditions
what is DISH
diffuse idiopathic skeletal hyperostosis
spondyloarthritides
how does DISH differ from ankylosing spondylitis
older age
minimal to no SI jt
no ARJC
ossification on ALL
no HLA rheumatic factor
painless or mild symptoms
what is the prevalence of DISH
2nd most common after OA
most common in type 2 diabetes
males more than females 50-70 yrs
what is the patho of DISH
ossification of ALL
what are the S&S of DISH
may be asymptomatic
back pain and stiffness, prolong or repetitive motion
possible neuro S&S
what is the referral for DISH
urgent MD
what does the prostate do
reproductive gland below the bladder that aids sperm function
what are RF for prostate cancer
age
genetics
chemical exposure
high fat, red meat diet
obesity
alcohol consumption
what is the prevalence for prostate cancer
only males 65 years
2 most common cancer in men
african americans
what are the S&S for prostate cancer
cancer S%S
lumbopelvic pain
bladder dysfunction
sexual dysfunction
urinary S&S
what is the patho for prostate cancer
disorganized gland cells infiltrate the prostate
what is the referral for prostate cancer
urgent referral MD
what should always be asked to male pt over 55 reporting LBP
always ask about if they have had prostate exam and PSA levels done
what is nephrolithiasis
kidney stones
what are RF that can lead to kidney stones
hyperexcretion of calcium - hypercalcuria or hyper thyroidism
not drinking water
obesity
high animal protein
what is the patho of a kidney stone
hard mass of salts composed of calcium > uric acid or other minerals
what are the S&S of kidney stones
acute/severe back and flank and some abdominal pain
radiating pain
bladder dysfunction
unrelenting pain
N&V due to pain
infection S&S
what can we do to check if they had kidney stones
murphy percussion test
pain with bladder palpation/percussion
what is the referral kidney stones
urgent, could be emergent if pain is severe
what is the role of the pancreas
enzymes for digestion, converting food/fluid to fuel
release insulin for sugar regulation
what can cause pancreatitis
chronic alcohol consumption and smoking
diabetes
obesity
trauma
genetics
infectious agents
what is pancreatitis
alcohol and sugar toxicity to pancreas cell
gallbladder bile refluxes into pancreas causing inflammation and possible fibrosis
what are S&S of pancreatitis
sharp R upper quadrant pain and radiates TL region
pain relieved with knees closer to chest
N&V
jaundice
swollen flank (Grey Turner)
swollen umbilicus (cullen)
what is the referral of pancreatitis
urgent and possible emergent depending on severity
what can worsen pancreatitis
worsened by fatty meals or drinking alcohol due to difficult digestion
what is an aneurysm
weakening in vessel wall
what is the prevalence of an aneurysm
aorta most common site
males>females
increasing frequency due to aging population
what are the RF for AAA
smoking
>50 yrs of age
male>female
vascular disease
genetics- family hx of AAA
why are smoking and vascular diseases a RF for AAA
increases BP so increases pressure on the weakened vessel
what can cause AAA
trauma
vascular disease
infection
what are AAA S&S
LBP, abdominal, flank pain
searing, ripping, or tearing back or abdominal pain
what can we do in a review for AAA
observation - abdominal heartbeat
palpation- non tender mass that pulses, just left of midline from umbilicus
bruit with auscultation over AA
absent or diminished pulse elsewhere
what is the referral for AAA
emergency referral
what is osteoporosis
persistent, progressive metabolic disease
low bone mass
impaired bone quality
decreased bone strength
enhanced risk of fx
what can cause primary osteoporosis
age related changes
hormone and calcium levels
physical activity
what can cause secondary osteoporosis
disease or medication
what is the most common metabolic bone disease
osteoporosis
what is the precursor to osteoporosis
osteopenia
what are the Rf for osteoporosis
low hormone levels
genetics
social habits
PA
meds
diet
how can low estrogen play a role in osteoporosis
bone can not regenerate and aids in calcium absorption
menopause and abnormal menses
how can low testosterone play a role in osteoporosis
bone can not regenerate
when should we ask a pt if they have a dxa scan
women- 65
men- 70
what is primary osteoporosis
metabolic disorder as osteoclastic activity > osteoblastic
what is secondary osteoporosis
endocrine disorder due to other condition that limit calcium regulating and sex hormones for bone health
what is the patho of osteoporosis
loss of inner cancellous bone
where are non traumatic fx more common with a patient with osteoporosis
femur
ribs
radius
how could osteoporosis show on an xray in the spine
loss of horizontal cancellous bone
multiple fx and loss of end plates
what are the S&S of osteoporosis
FHP
loss of height
increased thoracic and lumbar kyphosis
non traumatic fx
severe back pain especially with FLX, compression, Valsalva
what can you find in a scan with osteoporosis
ROM/RST- Pain/limitation, primarily in FLX but all directions
ST- pain with compression and PA, distraction relief
neuro- neg
what can we see in our biomechanical exam with osteoporosis
percussion +
unable to lay supine
what is the referral for osteoporosis
urgent
unless neuro signs
what can we do to treat osteoporosis
directional preference with edu, treatment, and activities (EXT, hyperext)
bracing
assistive devices
MET
MT
how can MET effect osteoporosis fx
bone integrity- improve denistiy
balance - bone impairments, risk of fx
walking and resistance training
what is the prognosis of a osteoporosis fx
8-12 weeks of conservative treatments
what is the MD Rx for osteoporosis fx
percutaneous vertebroplasty
what is osteomalacia
bone softening without loss of bone mass or brittleness as osteoporosis
what are the RF for osteomalacia
lack of dietary or sunlight vitamin D
malabsorption conditions including age that affect digestive and metabolic function
medications that alter Vit D, calcium, or phosphate
what can cause osteomalacia
insufficient calcium absorption
increase kidney phosphate loss due to kidney conditions, long term antacid use, hyperparathyroidism
what is the pathology of osteomalacia
lack of calcium salts
structure unchanged
primarily affects vertebra and femurs
what are the S&S of osteomalacia
more neuromuscular influence
LBP, pelvic, LE pain more in WB
myalgia/arthralgia
proximal m weakness and polyneuropathy
altered gait/increased falls
progress deformities
