Exam 3- Knee/Ankle Patho

Question 1

what conditions do we need 2 of to be at risk of DVT

Answer 1

venous stasis
hypercoagulability
damage to venous wall

Question 2

what is a DVT

Answer 2

partial or complete occlusion of a vein by a clot

Question 3

what are situations that lead to a DVT

Answer 3

prior DVT
hx of cancer, CHF, or lupus
major infection, sx, or trauma
present chemo
oral contraceptive or hormone therapy
clotting disorder
> 60 yrs

Question 4

where is DVT most common

Answer 4

LE deep veins

Question 5

what is most preventable hospital related death

Answer 5

DVT

Question 6

what is the most common cause of death/readmission after TKA/THA

Answer 6

DVT

Question 7

what is the pathology of a DVT

Answer 7

greater exposure to platelets and clotting factors to damage venous walls

Question 8

what can help prevent DVT

Answer 8

early and regular exercise
anticoagulants
compression stocking
avoid SAD
eliminate persistent smoking and drinking

Question 9

what are S&S of DVT

Answer 9

gradual onset of dull ache, tightness, and pain in the calf with RF
worse with walking and dependent positions
less relief with rest and elevation

Question 10

what are the review components of DVT

Answer 10

increased calf girth
calf pain and tenderness
redness and warmth

Question 11

what could a DVT lead to

Answer 11

pulmonary embolism

Question 12

what is the referral for DVT

Answer 12

emergency >3
urgent <2

Question 13

what is a pulmonary embolism

Answer 13

DVT that moves and lodges into a smaller arteries the lungs

Question 14

what are S&S of pulmonary embolism

Answer 14

SOB, wheezing, rapid breath
sudden sharp stabbing chest pain
mechanical motion

Question 15

what is the referral for pulmonary embolism

Answer 15

urgent <2/6
emergency >2/6

Question 16

what is PAD

Answer 16

ischemia leading to symptoms in the most distal area from blocked a

Question 17

what are RF/etiology of PAD

Answer 17

> 45 yrs of age
family hx of MI or sudden death before 55
smoker
sedentary
metabolic syndrome

Question 18

what is the pathology of PAD

Answer 18

narrowing of blood vessels limiting circulation

Question 19

what are S&S of PAD

Answer 19

LE pain, calf, activity and elevated
unilateral or bilateral
relieved with rest and dependent position

Question 20

what are the differences between DVT and PAD

Answer 20

DVT- pain with dependent, relief with elevation
PAD- pain with elevation, relief with dependent

Question 21

what are the review components of PAD

Answer 21

loss of pulse
TTP
muscle atrophy and weakness- MMT
loss of hair- ob
cool and bluish skin- ob
bruit on auscultation
ankle brachial index

Question 22

when is the ankle brachial index invalid

Answer 22

hx of HTN

Question 23

how do you perform ankle brachial index

Answer 23

assess post tib and brachial systolic BP in all extremities
divide ankle/brachial

Question 24

what does >.9 and >1.4 ABI mean

Answer 24

> .9= PAD
1.4= poorly compressed vv

Question 25

how could you differentiate calf pain due to PAD and stenosis

Answer 25

bicycle test

Question 26

what is the referral for PAD

Answer 26

urgent

Question 27

what is osteochondritis dissecans

Answer 27

damage to subchondral bone

Question 28

where is osteochondritis dissecans most common at

Answer 28

younger boys medial femoral condyle and talus

Question 29

what can cause osteochondritis dissecans

Answer 29

jt RT or shear trauma

Question 30

what is the pathology of osteochondritis dissecans

Answer 30

ischemia then separation of subchondral from convex and WB bones

Question 31

what are S&S of osteochondritis dissecans

Answer 31

persistent severe pain jt locking, catching, and swelling hypermobility plus ARJC cannot progress to WB

Question 32

what are review components of osteochondritis dissecans

Answer 32

ROM- limited and painful with ext RST- weak and painful end range ext comp + TTP at femoral condyle

Question 33

what is the referral for osteochondritis dissecans

Answer 33

urgent

Question 34

what factors can play a role in healing for osteochondritis dissecans

Answer 34

higher BMI passive restraints m imbalances impaired proprioception

Question 35

what is the management for an unstable lesion for osteochondritis dissecans

Answer 35

sx for resurfacing or fixation

Question 36

what is the management for stable lesion for osteochondritis dissecans

Answer 36

rx for instability with ARJC

Question 37

what are RF for reactive arthritis

Answer 37

IV drug users high sexual activity infrequent pelvic exams weaker immune system

Question 38

where does septic arthritis infection come from

Answer 38

site of primary infection

Question 39

where are acute infection come from

Answer 39

remote site from primary infection

Question 40

where is reactive arthritis most common

Answer 40

larger LE jt- knee and ankle

Question 41

what can cause reactive arthritis

Answer 41

respiratory infection GI, urinary, and colon infection

Question 42

what is the pathology of reactive arthritis

Answer 42

bacteria stimulates antibodies creating inflammation and tissue damage

Question 43

what are S&S of reactive arthritis

Answer 43

infection S&S autoimmune S&S

Question 44

what are review components of reactive arthritis

Answer 44

ob- redness, swelling vitals- temp ARJC S&S palpation- TTP, warm, swollen tender lymph nodes

Question 45

what is the referral for reactive arthritis

Answer 45

urgent

Question 46

what is diabetes mellitus

Answer 46

chronic systemic disorder characterized by hyperglycemia and abnormal metabolism

Question 47

what is insulin

Answer 47

released from pancreas lowers blood sugar stores fat

Question 48

what is type 1 diabetes

Answer 48

auto immunity affecting the pancreas that produces insulin deficiency of insulin production

Question 49

what is type 2 diabetes

Answer 49

excessive dietary sugar and other simple carbohydrates limits effect of insulin

Question 50

how can more sugar affect insulin

Answer 50

more sugar = more insulin production = more fat

Question 51

what are cardinal S&S for diabetes

Answer 51

frequent urination dry mouth excessive thirst decreased skin turgor blurry vision weakness/fatigue

Question 52

what are the neuropathies diabetes can cause

Answer 52

sensory motor autonomic

Question 53

how is sensory affected by diabetes

Answer 53

peripheral n hyposensitivity or numbness less aware of heart attack

Question 54

how is motor affected by diabetes

Answer 54

weakness of mm due to innervation of peripheral n

Question 55

how is autonomic affected by diabetes

Answer 55

diminished pulses necrosis poor healing stroke cardiac dz

Question 56

what can diabetes lead to if not managed well

Answer 56

kidney dz and blindness cognitive dysfunction- alzheimers (type 3)

Question 57

what are the review components of diabetes

Answer 57

ob- charcot foot, dry mouth, cognitive decline, fruity breath ROM- limited and painful RST- possible weakness neuro- diminshed sensation, + dural palaption- diminished pulses

Question 58

due to persistent inflammation and impaired circulation of diabetes, what are these pts more susceptible to

Answer 58

carpal tunnel syndrome adhesive capsulitis trigger finger delayed healing nociplastic pain

Question 59

why should diabetics exercise 3 10 minute bouts

Answer 59

eat, burn sugar, eat, burn sugar

Question 60

why should diabetics wait 1-2 hrs after a meal to workout

Answer 60

meals increase blood sugar and insulin and exercise work to decrease blood sugar

Question 61

what education can be given to diabetic pts

Answer 61

wear accommodating shoes and socks examine feet avoid alcohol and cortisone shots

Question 62

what is systemic inflammation a primary contributor to

Answer 62

diabetes HTN high triglycerides low HDL being overweight

Question 63

what is gout

Answer 63

metabolic disorder with elevated levels of uric acid and deposition of urate crystals

Question 64

where is the most common site for gout

Answer 64

1st MTP most common crystallopathy

Question 65

what are the RF for gout

Answer 65

family hx decreased renal function high fructose SAD high nitrogen diets

Question 66

what can cause gout

Answer 66

genetic

Question 67

what is the pathology of gout

Answer 67

uric acid typically forms from breaking down cellular waste in the bloodstream kidneys unable to process uric acid

Question 68

what are the symptoms of gout

Answer 68

sudden onset of severe jt pain night or morning increasing frequency

Question 69

when do symptoms of gout start

Answer 69

10-12 yrs of hyperuricemia

Question 70

what are the review components of gout

Answer 70

ob- redness, swelling palpation- warmth, fever ROM- limited and painful, ext RST- possible weak CM- consistent block

Question 71

what can we do to help pt with gout

Answer 71

education on causes and RF

Question 72

what is osteomyelitis

Answer 72

inflammation of bone

Question 73

where is osteomyelitis most common

Answer 73

tarsal metatarsal tibia femur

Question 74

what are RF for osteomyelitis

Answer 74

immunosuppression chronic illness (diabetes) IV drug use jt replacement

Question 75

what can cause osteomyelitis

Answer 75

microorganism binds to cartilage spreads quickly through metaphysis

Question 76

what are S&S of osteomyelitis

Answer 76

gradual onset of deep achy pain/stiffness infection S&S localized and progressive pain limits motion and WB

Question 77

what are the review components of osteomyelitis

Answer 77

ob- painful asymmetric gait, red and swollen temperature- warmth, fever ROM- limited and painful, ext RST- possible weak CM- consistent block