Exam 3- Knee/Ankle Patho Flashcards
what conditions do we need 2 of to be at risk of DVT
venous stasis
hypercoagulability
damage to venous wall
what is a DVT
partial or complete occlusion of a vein by a clot
what are situations that lead to a DVT
prior DVT
hx of cancer, CHF, or lupus
major infection, sx, or trauma
present chemo
oral contraceptive or hormone therapy
clotting disorder
> 60 yrs
where is DVT most common
LE deep veins
what is most preventable hospital related death
DVT
what is the most common cause of death/readmission after TKA/THA
DVT
what is the pathology of a DVT
greater exposure to platelets and clotting factors to damage venous walls
what can help prevent DVT
early and regular exercise
anticoagulants
compression stocking
avoid SAD
eliminate persistent smoking and drinking
what are S&S of DVT
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
what are the review components of DVT
increased calf girth
calf pain and tenderness
redness and warmth
what could a DVT lead to
pulmonary embolism
what is the referral for DVT
emergency >3
urgent <2
what is a pulmonary embolism
DVT that moves and lodges into a smaller arteries the lungs
what are S&S of pulmonary embolism
SOB, wheezing, rapid breath
sudden sharp stabbing chest pain
mechanical motion
what is the referral for pulmonary embolism
urgent <2/6
emergency >2/6
what is PAD
ischemia leading to symptoms in the most distal area from blocked a
what are RF/etiology of PAD
> 45 yrs of age
family hx of MI or sudden death before 55
smoker
sedentary
metabolic syndrome
what is the pathology of PAD
narrowing of blood vessels limiting circulation
what are S&S of PAD
LE pain, calf, activity and elevated
unilateral or bilateral
relieved with rest and dependent position
what are the differences between DVT and PAD
DVT- pain with dependent, relief with elevation
PAD- pain with elevation, relief with dependent
what are the review components of PAD
loss of pulse
TTP
muscle atrophy and weakness- MMT
loss of hair- ob
cool and bluish skin- ob
bruit on auscultation
ankle brachial index
when is the ankle brachial index invalid
hx of HTN
how do you perform ankle brachial index
assess post tib and brachial systolic BP in all extremities
divide ankle/brachial
what does >.9 and >1.4 ABI mean
> .9= PAD
1.4= poorly compressed vv
how could you differentiate calf pain due to PAD and stenosis
bicycle test
what is the referral for PAD
urgent
what is osteochondritis dissecans
damage to subchondral bone
where is osteochondritis dissecans most common at
younger boys
medial femoral condyle and talus
what can cause osteochondritis dissecans
jt RT or shear trauma
what is the pathology of osteochondritis dissecans
ischemia then separation of subchondral from convex and WB bones
what are S&S of osteochondritis dissecans
persistent severe pain
jt locking, catching, and swelling
hypermobility plus ARJC
cannot progress to WB
what are review components of osteochondritis dissecans
ROM- limited and painful with ext
RST- weak and painful end range ext
comp +
TTP at femoral condyle
what is the referral for osteochondritis dissecans
urgent
what factors can play a role in healing for osteochondritis dissecans
higher BMI
passive restraints
m imbalances
impaired proprioception
what is the management for an unstable lesion for osteochondritis dissecans
sx for resurfacing or fixation
what is the management for stable lesion for osteochondritis dissecans
rx for instability with ARJC
what are RF for reactive arthritis
IV drug users
high sexual activity
infrequent pelvic exams
weaker immune system
where does septic arthritis infection come from
site of primary infection
where are acute infection come from
remote site from primary infection
where is reactive arthritis most common
larger LE jt- knee and ankle
what can cause reactive arthritis
respiratory infection
GI, urinary, and colon infection
what is the pathology of reactive arthritis
bacteria stimulates antibodies creating inflammation and tissue damage
what are S&S of reactive arthritis
infection S&S
autoimmune S&S
what are review components of reactive arthritis
ob- redness, swelling
vitals- temp
ARJC S&S
palpation- TTP, warm, swollen tender lymph nodes
what is the referral for reactive arthritis
urgent
what is diabetes mellitus
chronic systemic disorder characterized by hyperglycemia and abnormal metabolism
what is insulin
released from pancreas
lowers blood sugar
stores fat
what is type 1 diabetes
auto immunity affecting the pancreas that produces insulin
deficiency of insulin production
what is type 2 diabetes
excessive dietary sugar and other simple carbohydrates limits effect of insulin
how can more sugar affect insulin
more sugar = more insulin production = more fat
what are cardinal S&S for diabetes
frequent urination
dry mouth
excessive thirst
decreased skin turgor
blurry vision
weakness/fatigue
what are the neuropathies diabetes can cause
sensory
motor
autonomic
how is sensory affected by diabetes
peripheral n hyposensitivity or numbness
less aware of heart attack
how is motor affected by diabetes
weakness of mm due to innervation of peripheral n
how is autonomic affected by diabetes
diminished pulses
necrosis
poor healing
stroke
cardiac dz
what can diabetes lead to if not managed well
kidney dz and blindness
cognitive dysfunction- alzheimers (type 3)
what are the review components of diabetes
ob- charcot foot, dry mouth, cognitive decline, fruity breath
ROM- limited and painful
RST- possible weakness
neuro- diminshed sensation, + dural
palaption- diminished pulses
due to persistent inflammation and impaired circulation of diabetes, what are these pts more susceptible to
carpal tunnel syndrome
adhesive capsulitis
trigger finger
delayed healing
nociplastic pain
why should diabetics exercise 3 10 minute bouts
eat, burn sugar, eat, burn sugar
why should diabetics wait 1-2 hrs after a meal to workout
meals increase blood sugar and insulin and exercise work to decrease blood sugar
what education can be given to diabetic pts
wear accommodating shoes and socks
examine feet
avoid alcohol and cortisone shots
what is systemic inflammation a primary contributor to
diabetes
HTN
high triglycerides
low HDL
being overweight
what is gout
metabolic disorder with elevated levels of uric acid and deposition of urate crystals
where is the most common site for gout
1st MTP
most common crystallopathy
what are the RF for gout
family hx
decreased renal function
high fructose SAD
high nitrogen diets
what can cause gout
genetic
what is the pathology of gout
uric acid typically forms from breaking down cellular waste in the bloodstream
kidneys unable to process uric acid
what are the symptoms of gout
sudden onset of severe jt pain
night or morning
increasing frequency
when do symptoms of gout start
10-12 yrs of hyperuricemia
what are the review components of gout
ob- redness, swelling
palpation- warmth, fever
ROM- limited and painful, ext
RST- possible weak
CM- consistent block
what can we do to help pt with gout
education on causes and RF
what is osteomyelitis
inflammation of bone
where is osteomyelitis most common
tarsal
metatarsal
tibia
femur
what are RF for osteomyelitis
immunosuppression
chronic illness (diabetes)
IV drug use
jt replacement
what can cause osteomyelitis
microorganism binds to cartilage
spreads quickly through metaphysis
what are S&S of osteomyelitis
gradual onset of deep achy pain/stiffness
infection S&S
localized and progressive pain
limits motion and WB
what are the review components of osteomyelitis
ob- painful asymmetric gait, red and swollen
temperature- warmth, fever
ROM- limited and painful, ext
RST- possible weak
CM- consistent block
