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DPT 740/1: Clin Med 1 > EXAM 1- LBP Patho > Flashcards

EXAM 1- LBP Patho Flashcards

1
Q

what is the normal pH function

A

7.35-7.45
kidneys remove acids and keep bases
lungs balance the acidic CO2

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2
Q

what is respiratory acidosis

A

hypoventilation and an accumulation of acidic CO2

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3
Q

what are the urinary S&S

A

pain in trunk, flank, pelvic region
discoloration
urinary changes
dysfunction
nocturia

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4
Q

what is in a urinary review

A

most from Hx
observation of urine- unlikely, ask
pain with kidney percussion
pain with bladder palpation/percussion

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5
Q

what are the functions of the urinary system

A

filter fluid from renal blood flow
stimulate RBC production
blood pressure regulation
convert vitamin D to active form

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6
Q

what is retained when filtering fluid in urinary system

A

electrolytes and acid/base balance

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7
Q

what are reproductive S&S

A

pain in pelvis, Lb, abdominal regions
dysfunction- sexual and bowel
abnormal discharge/menstruation

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8
Q

what are unknown pregnancy indications

A

polyuria
breast tenderness
fatigue
heartburn
constipation

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9
Q

what is in a review for the reproductive system

A

most from hx
observation unlikely

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10
Q

what is the function of metabolic system

A

conversion of foods and liquids into energy and building blocks
elimination of waste
fluid and electrolyte balance

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11
Q

why are metabolic S&S so varied

A

due to imbalance of electrolytes, fluid and pH balance

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12
Q

what are the most common causes of polyuria and/or dehydration

A

diabetes
kidney dysfunction
malignancy
alcohol
medication side affects
burns
diarrhea
N&V

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13
Q

describe sodium

A

maintains fluid volume and membrane potential between cells for messages to and from the CNS

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14
Q

what is the most frequent electrolyte disorder

A

hyponatremia- low sodium, neuro S&S

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15
Q

describe potassium

A

maintains fluid volume

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16
Q

what is hypokalemia

A

cardiac arrythmias

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17
Q

what is hyperkalemia

A

muscle dysfunction

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18
Q

describe calcium

A

involved with bone, muscle action, nerve impulses, circulation, and hormones

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19
Q

describe phosphorus

A

bones and teeth
crucial role in growth, maintenance, and repair of all tissues

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20
Q

describe bicarbonate

A

works as an acid buffer
diarrhea is the main loss of bicarbonate

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21
Q

describe magnesium

A

mainly involved in neuromuscular functions

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22
Q

describe chloride

A

regulates fluid in and out of cells

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23
Q

what are S&S of fluid and electrolyte imbalance

A

skin- loss of elasticity, temp
neuromuscular - fatigue, cramp, twitch
CNS- memory loss, depression, seizures
cardio- tachycardia, altered respirations

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24
Q

what can cause respiratory acidosis

A

disorders affecting respiration
drugs suppressing respiration - opiods/muscle relaxers
sleep apnea

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25
Q

what are S&S of respiratory acidosis

A

headache
anxiety
memory loss
sleep disturbance
incoordination/tremor

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26
Q

what is respiratory alkalosis

A

hyperventilation leading to loss of acidic CO2

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27
Q

what can cause respiratory alkalosis

A

pulmonary conditions
anxiety
anemia with less oxygenation

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28
Q

what are S&S of respiratory alkalosis

A

SOB
light headedness

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29
Q

what is metabolic acidosis

A

most common acid-base abnormality
accumulation of acidic H ions

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30
Q

what can cause metabolic acidosis

A

diabetes and the build up of ketones
diarrhea/dehydration
kidney disease

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31
Q

what are S&S of metabolic acidosis

A

long deep breath that is fruity
polyuria
dry mouth
excessive thirst
blurry vision
weakness/fatigue

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32
Q

what is metabolic alkalosis

A

accumulation of bicarbonate base

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33
Q

what can cause metabolic alkalosis

A

vomiting by loss of stomach acid
kidney disorders
excessive antacid
diarrhea

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34
Q

what are S&S of metabolic alkalosis

A

headache
neuromuscular- paresthesia, twitch, seizures
muscle alterations

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35
Q

what is in a metabolic review

A

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

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36
Q

what can we observe in a metabolic review

A

muscle twitch
altered respiration
memory loss
incoordination
dry mouth
fruity breath

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37
Q

what are commons signs of infection

A

malaise
fever, chills, sweats
N&V
enlarged, tender lymph nodes
signs specific to the infected systems

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38
Q

what is different about the infection symptoms in an older individual

A

mentation changes
subnormal body temp
bradycardia or tachy
fatigue/lethargy

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39
Q

what is in a systems review for infection

A

hx
observation- redness, swelling
palpation- lymph nodes, heat, swelling
vitals- temp high

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40
Q

what are common S&S of the immune system

A

GI pain/dysfunction
muscle or joint pain
skin and weight changes
typically affecting more than 1 part of the body
emotional changes

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41
Q

what is in an immune system review

A

hx
observation- persistent swelling or pitting edma
high temperature
palpation of swollen and tender lymph nodes

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42
Q

what are cancer S&S

A

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

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43
Q

what is in the cancer review

A

hx and observation
palpation of lymph nodes- NON tender
high temperature

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44
Q

what are the main functions of the cardiovascular system and primarily with what two other systems

A

respiratory and nervous
circulate oxygenated blood throughout body
circulate deoxygenated blood to lungs

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45
Q

what are common S&S of the cardiovascular system

A

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

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46
Q

what is in the cardiovascular review

A

hx
observation - SOB, wheezing, sweating
vitals- HR, RR, BP
ankle-brachial index

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47
Q

what are common S&S of respiratory system

A

pain in neck and upper shoulder
thorax pain
digital clubbing
SOB
decreased breath sounds
hyperresonance with percussion

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48
Q

what is in the respiratory review

A

hx
observation- cyanosis, digital clubbing, SOB
vitals- RR
decreased breath sounds
percussions

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49
Q

what are common S&S of the GI system

A

dysphagia
N&V
food eversion/intolerance
indigestion/heartburn
full feeling (bloated)

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50
Q

what is in a GI review

A

hx
observation - wavelike motion over intestines, difficulty swallowing
abdominal quadrant assessment

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51
Q

LMN vs UMN: increased or spastic muscle tone

A

UMN

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52
Q

LMN vs UMN: incontinence or leakage bladder

A

LMN

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53
Q

LMN vs UMN: hypoactive DTR

A

LMN

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54
Q

LMN vs UMN: multi-segmental diminished with dermatomes

A

UMN

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55
Q

LMN vs UMN: spastic or retentive bladder

A

UMN

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56
Q

LMN vs UMN: single segment muscle fatiguing weakness

A

LMN

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57
Q

LMN vs UMN: superficial reflex is hypoactive

A

UMN

58
Q

what are the S&S of lumbar myelopathy

A

extreme spinal pain
multisegmental weakness/numbness
spastic or rententive bladder
dtr= hyperactive
UMN +
stress test +

59
Q

what are the S&S of spinal malignancy

A

spinal pain- unfamiliar/severe
bony landmark alterations - fx
unable to lay flat
mechanical pain thats random
tenderness to palpation

60
Q

how can spinal infection happen

A

develops 2-3 years after initial air droplet infection into lungs
lungs to vb to disc to adjacent vb

61
Q

how does a spinal infection spread

A

lymph nodes and blood

62
Q

what can happen if an abcsess grows in a spinal infection

A

nerve root irritation
vb collapse/fx
cord compression

63
Q

what can happen if spinal infection goes untreated

A

neuro S&S influence LE coordination including bowel and bladder

64
Q

what are the early S&S of spinal infection

A

age related changes like back pain and stiffness

65
Q

how can spinal infection be shown on xray

A

body destruction
TB abscess
loss of height
sclerotic end plate
diminished disc space

66
Q

what are the RF for a spinal infection

A

immunosuppression
surgery
IV drug use
social depravation
hx of TB

67
Q

what are the S&S of spinal infection

A

localized and progressive pain that limits motion- flexion
mechanical pain
stress test + for disc
unexplained weight loss
TTP, percussion, vibration

68
Q

what is osteomyelitis

A

bone infection

69
Q

what is discitis

A

disc infection

70
Q

where is the infection more common in lumbar region

A

the disc

71
Q

what is cauda equina syndrome

A

compression of some degree of 20 sp nn that originate from the end of the spinal cord

72
Q

what are the S&S of cauda equina syndrome

A

hx of LBP
bowel/bladder incontinence
sexual dysfunction
paresthesia/decreased sensation in multiple dermatomes
multiple myotome weakness
hypoactive DTR
+ dural mobility

73
Q

what is the referral for cauda equina syndrome

A

emergency due to multiple spinal nn

74
Q

what is ankylosing spondylitis

A

autoimmune disease
chronic inflammation at cartilage, tendon, ligament, and synovium attachments to bone
erosive osteopenia and bony overgrowth
leads to fusion of involved joints

75
Q

what are S&S of spondyloarthritides

A

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

76
Q

what are the S&S of ankylosing spondylitis

A

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

77
Q

what can we observe with ankylosing spondylitis

A

hyperkyphosis
loss of lumbar lordosis

78
Q

what can be found in a scan for ankylosing spondylitis

A

multiple direction of limited motion
combined motion= always limited
stress test with prolong hold is painful

79
Q

what is the referral for ankylosing spondylitis

A

urgent referral for rheumatologist

80
Q

what can be found in a biomechanical exam for ankylosing spondylitis

A

multiple direction hypomobile accessory motion
limited thorax excursion with manubrial and rib springs

81
Q

how do we treat ankylosing spondylitis

A

be sensitive to trauma in patients
fall risk
gentle ROM and exercise considering fragile
postural education

82
Q

what are complications for ankylosing spondylitis

A

osteoporosis
fractures
craniovertebral subluxations
stenosis
fusion in upright or more often forward bent position
extraarticular conditions

83
Q

what is DISH

A

diffuse idiopathic skeletal hyperostosis
spondyloarthritides

84
Q

how does DISH differ from ankylosing spondylitis

A

older age
minimal to no SI jt
no ARJC
ossification on ALL
no HLA rheumatic factor
painless or mild symptoms

85
Q

what is the prevalence of DISH

A

2nd most common after OA
most common in type 2 diabetes
males more than females 50-70 yrs

86
Q

what is the patho of DISH

A

ossification of ALL

87
Q

what are the S&S of DISH

A

may be asymptomatic
back pain and stiffness, prolong or repetitive motion
possible neuro S&S

88
Q

what is the referral for DISH

A

urgent MD

89
Q

what does the prostate do

A

reproductive gland below the bladder that aids sperm function

90
Q

what are RF for prostate cancer

A

age
genetics
chemical exposure
high fat, red meat diet
obesity
alcohol consumption

91
Q

what is the prevalence for prostate cancer

A

only males 65 years
2 most common cancer in men
african americans

92
Q

what are the S&S for prostate cancer

A

cancer S%S
lumbopelvic pain
bladder dysfunction
sexual dysfunction
urinary S&S

93
Q

what is the patho for prostate cancer

A

disorganized gland cells infiltrate the prostate

94
Q

what is the referral for prostate cancer

A

urgent referral MD

95
Q

what should always be asked to male pt over 55 reporting LBP

A

always ask about if they have had prostate exam and PSA levels done

96
Q

what is nephrolithiasis

A

kidney stones

97
Q

what are RF that can lead to kidney stones

A

hyperexcretion of calcium - hypercalcuria or hyper thyroidism
not drinking water
obesity
high animal protein

98
Q

what is the patho of a kidney stone

A

hard mass of salts composed of calcium > uric acid or other minerals

99
Q

what are the S&S of kidney stones

A

acute/severe back and flank and some abdominal pain
radiating pain
bladder dysfunction
unrelenting pain
N&V due to pain
infection S&S

100
Q

what can we do to check if they had kidney stones

A

murphy percussion test
pain with bladder palpation/percussion

101
Q

what is the referral kidney stones

A

urgent, could be emergent if pain is severe

102
Q

what is the role of the pancreas

A

enzymes for digestion, converting food/fluid to fuel
release insulin for sugar regulation

103
Q

what can cause pancreatitis

A

chronic alcohol consumption and smoking
diabetes
obesity
trauma
genetics
infectious agents

104
Q

what is pancreatitis

A

alcohol and sugar toxicity to pancreas cell
gallbladder bile refluxes into pancreas causing inflammation and possible fibrosis

105
Q

what are S&S of pancreatitis

A

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)

106
Q

what is the referral of pancreatitis

A

urgent and possible emergent depending on severity

107
Q

what can worsen pancreatitis

A

worsened by fatty meals or drinking alcohol due to difficult digestion

108
Q

what is an aneurysm

A

weakening in vessel wall

109
Q

what is the prevalence of an aneurysm

A

aorta most common site
males>females
increasing frequency due to aging population

110
Q

what are the RF for AAA

A

smoking
>50 yrs of age
male>female
vascular disease
genetics- family hx of AAA

111
Q

why are smoking and vascular diseases a RF for AAA

A

increases BP so increases pressure on the weakened vessel

112
Q

what can cause AAA

A

trauma
vascular disease
infection

113
Q

what are AAA S&S

A

LBP, abdominal, flank pain
searing, ripping, or tearing back or abdominal pain

114
Q

what can we do in a review for AAA

A

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

115
Q

what is the referral for AAA

A

emergency referral

116
Q

what is osteoporosis

A

persistent, progressive metabolic disease
low bone mass
impaired bone quality
decreased bone strength
enhanced risk of fx

117
Q

what can cause primary osteoporosis

A

age related changes
hormone and calcium levels
physical activity

118
Q

what can cause secondary osteoporosis

A

disease or medication

119
Q

what is the most common metabolic bone disease

A

osteoporosis

120
Q

what is the precursor to osteoporosis

A

osteopenia

121
Q

what are the Rf for osteoporosis

A

low hormone levels
genetics
social habits
PA
meds
diet

122
Q

how can low estrogen play a role in osteoporosis

A

bone can not regenerate and aids in calcium absorption
menopause and abnormal menses

123
Q

how can low testosterone play a role in osteoporosis

A

bone can not regenerate

124
Q

when should we ask a pt if they have a dxa scan

A

women- 65
men- 70

125
Q

what is primary osteoporosis

A

metabolic disorder as osteoclastic activity > osteoblastic

126
Q

what is secondary osteoporosis

A

endocrine disorder due to other condition that limit calcium regulating and sex hormones for bone health

127
Q

what is the patho of osteoporosis

A

loss of inner cancellous bone

128
Q

where are non traumatic fx more common with a patient with osteoporosis

A

femur
ribs
radius

129
Q

how could osteoporosis show on an xray in the spine

A

loss of horizontal cancellous bone
multiple fx and loss of end plates

130
Q

what are the S&S of osteoporosis

A

FHP
loss of height
increased thoracic and lumbar kyphosis
non traumatic fx
severe back pain especially with FLX, compression, Valsalva

131
Q

what can you find in a scan with osteoporosis

A

ROM/RST- Pain/limitation, primarily in FLX but all directions
ST- pain with compression and PA, distraction relief
neuro- neg

132
Q

what can we see in our biomechanical exam with osteoporosis

A

percussion +
unable to lay supine

133
Q

what is the referral for osteoporosis

A

urgent
unless neuro signs

134
Q

what can we do to treat osteoporosis

A

directional preference with edu, treatment, and activities (EXT, hyperext)
bracing
assistive devices
MET
MT

135
Q

how can MET effect osteoporosis fx

A

bone integrity- improve denistiy
balance - bone impairments, risk of fx
walking and resistance training

136
Q

what is the prognosis of a osteoporosis fx

A

8-12 weeks of conservative treatments

137
Q

what is the MD Rx for osteoporosis fx

A

percutaneous vertebroplasty

138
Q

what is osteomalacia

A

bone softening without loss of bone mass or brittleness as osteoporosis

139
Q

what are the RF for osteomalacia

A

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

140
Q

what can cause osteomalacia

A

insufficient calcium absorption
increase kidney phosphate loss due to kidney conditions, long term antacid use, hyperparathyroidism

141
Q

what is the pathology of osteomalacia

A

lack of calcium salts
structure unchanged
primarily affects vertebra and femurs

142
Q

what are the S&S of osteomalacia

A

more neuromuscular influence
LBP, pelvic, LE pain more in WB
myalgia/arthralgia
proximal m weakness and polyneuropathy
altered gait/increased falls
progress deformities

DPT 740/1: Clin Med 1 (7 decks)

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