Let 15-18b Flashcards
What is asthma
A disease characterized by increased responsiveness of the trachea and bronchi to various stimuli and manifested by widespread narrowing of the airways
Clinical def of asthma
any patient with recurrent (>3) episodes of wheezing and or dyspnea
- can cause
- -sob
- -tightness in the chest
- -coughing
- -wheezing
Risk factors of asthma
Genetic- The body predisposition to develop IgE
Environmental
chemical agents (tabaco etc)
Inflammatory triggers
Symptom triggers
What is exercise induced asthma+ mechanism + durations
Coughing, wheezin, chest tightness
mechanism- increases respiratory rate + cold dry air thru month
-Airways narrow->reduced air flow->coughing wheezing etc
Duration
After- begin during and usually worse 5-20m after stop
late- 4-12 after but ss are less severe
Tests used for asthma
Spirometry
Peark flow rate
challenge test (deliberately triggering airway obstruction)
Exhaled nitric oxide (marker for asma severity)
Essential components of asthma care
assessment and monitoring patient education control of factors contributing to asthma severity pharmacological tx pt health and wellness
possible treatable traits of chronic asthmatic
nutritional def obesity reconditioning cachexia fall risk gerd sleep apnea stress etc
Med management of asthma
Bronchodialators (beta agonists) Antiinflamatories Inhaled NSAIDS Inhaled steroids Oral Steroids
Asthmatic emergencies in children ages 5-11
s/s of sig trouble breathing
- persistent coughing or wheezing
- no improvement after inhaler
- unable to speak w/o gasping
- peak flow meter (in red)
- severe asthma attack
tx traits of asthma for chiros
spinal mobility myofasial tension/triggers rehab program trigger exposure referal for sensitive testing nutritional options
Enuresis definition
Defined as the leakage of urine in discrete portion of sleeping
-atleast 5yold or older
What is primary enuresis
Never been previously dry
-dx not before 5years old
(15% have natural resolution rate w/o tx)
What is secondary enuresis and pot causes
Restart bedwetting when previous dry period of at least 6 m
Multiple causes:
- UTI
- Small bladder capacity
- Anatomic abnormalities
- psychological distress/anxiety
- family stress
what is mono symptomatic enuresis
the pt is w/o
- lower tract sympptoms
- hx of bladder dysfunction
- night time wetting with day time control
What is poly symptomatic enuresis
nocturnal + day incontinence w other symptoms:
- urgency, hesitancy, straining
- weak stream
- intermittency
- holding manoeuvres
- feeling of incomplete emptying
- post maturation dribble
Genetics of eneritics
75% risk where both parents were
45% risk where only one parent was
15% where there is no parental hx
multifactorial causation of enuresis
- impaired cerebral cortex maturation
- rapid eye mvmt sleep disorder
- disturbed circadian rhythm
- genertic disorders
- psychiatric disorders
- kidney probs
overall tx methods for primary nocturnal enuresis
timed awakenings alarms biofeedback hypnosis acu meds CBT diet
what are the core symptoms of ADHD (3)
- Inattention
- Impulsivity
- Hyperactivity
diagnostic criteria for ADHD
- Inattention (need 4)
- need a calm/quiet to get work done
- asks things to be repeated
- easily distracted
- confuses details
- doesnt finish what started
- hears but doesnt listen
- difficulty concentrating - Impulsivity (3 of following)
- Calls out in class
- extrememly excitable
- trouble waiting turns
- talks excessively
- disrupts children - Hyperactivity (3 of following)
- climbs onto cabinets / furniture
- always on go
- figids/squirms
- does things in a loud/noisy way
- must always be doing something
Other key adhd criteria other than 3 categories
Onset before 7
Duration of at least 6 months
present in at least 2 settings
Epidemiology of ADHD
1-13%
3-4x mc in boys than girls
etiology of ADHD
combo of genetic, neuro and env factors contribute to pathogenesis
non inherited factors- brain injury, birth complications, inter exposure to alcohol/tabaco, low birth weight, hypixia
Neurology of ADHD
sig brain areas w slow brain activity:
- Frontal lobes
- Inhibitory mechanism of the cortex
- libic system
- reticular activating system
Chiro care for ADHD
Insufficent evidence to evaluate efficacy of chiro care for paediatric and adolescent ADHD
(67.6% of fams use CAM for management)
Examples of tx traits of child living w ADHD
gross motor energy management fall risk reduction teaching proportionality look ahead activites signs/signals memory tasks somatic stin
Prevellenece of LBP in adolescnece
25-50%
more prev in 8-10yearl olds and 14-16
(1/3 trauma, 1/3 develipmental, 1/3 inf, neoplasm etc)
effect of backpack weight on children
carrying more than 10% of body weight-> increased incidence of pain in neck and back
(15% changes all angles pertaining to head, neck, trunk etc)
what % of pediatric athletes have LBP
10-15%
Scheuermanns kyphosis- age, sex, pain
dx bw 13-17
m
Usually asymptomatic (if pain then exacerbated by forward flexion, relieved by rest)
Discitis age group
<4
usually staph aureus
mc form of downs
trisomy 21
can CAM therpies help reduce antibiotic resistence
In paediatric practice an emphasis on accurate diagnosis, control or environmental risk and utilization off CAM could help reduce antibiotic resistance
management of otis media
severe our with complications that fail to improve with observation of CAM (48-72hrs) should be tx with antibiotics
what is the theory of chiro and set
control of eustachian tube dialation is by tensor deli palatine and elevator veli palini
-could be affect via tx to c1-4
what is mild illness considered in Acute otitis media
otalgia + middle ear effusion
Acute otitis external and s/s
an inflammation, irritation or infection of the outer ear and ear canal
s/s
- intense otalgia
- otorrhea
- fullness
- hearing loss
what is the malignant for of otis externa
inf to temporal bone (necrotizing otis external)
immunocompromised pt
elderly diabetics
General tx for otis media
antibiotics valsalva maneuver myringotomy and tympanovstomy diet gum massage meds
infantile vs juvenile vs adolescent scoliosis
infantile- seen by 3
juvenile- seen by 4-10
adolescent- 10 to skeletal maturity
Adolelesent idiopathic scoliosis represents what % of all spinal curves
85%
3 Basic AIS etiologoies
- disporortionate growth velocities
- nervous system dysfunction (altered sensory inputs)
- endocribne system involvement (calmodulin def)
What were the conclusions of school screening study
only a small% of curves will undergo progression
-pattern of the curve according to curve direction and sex of the child was found to be a key indicator of which curves will progress
vision and hearing associated probs with scoliosis
vision impaired inv have 5x grater incidence of scoliosis
hearing impaired inv have 3/7 times less incidence of scoliosis
AIS progression in adulthood
more progressive bw detection and skeletal maturity, less rapid in next 30 years
(1 degree progression per year)
for curves <20 what should be done
Obs
- exercise, postural, economic awareness
- cognitive/image/perception/personal goals
- refer to physician
for curves 20-40 what does be dome
bracing may be required if their is documented progression
-1/3 of curves in this range dont progress
for curves >40 degrees what should be done
surgery may be indicated
