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ClinMed II > Low Back Pathologies 2 > Flashcards

Low Back Pathologies 2 Flashcards

1
Q

what is diffuse idiopathic skeletal hyperostosis

A

type of spindyloarthropathy or spondyloarthritide

aka DISH

often confused with ankylosing spondylitis

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2
Q

how is DISH different from ankylosing spondylosis

A

older ages
minimal to no SI jt involvement
no ARDC or ARJC
ossifications on ALL
no HLA rheumatic factor
relatively painless/mild symptoms
incidental discovery

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3
Q

incidence/prevalence of DISH

A

2nd most common type of arthritis next to OA

most commonly effects spine, right side of the thoracic region, but also lumbar

most often in people with type II diabetes

males > females 50-70 years of age

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4
Q

etiology of DISH

A

unknown

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5
Q

pathogenesis of DISH

A

ossification or bony outgrowths at entheses particularly of the spine but NOT bridging joints

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6
Q

S&S of spondyloarthropathies or spondyloarthritides

A

autoimmune
multi joint pain and inflammation
familial predisposition
extraarticular involvement of eyes, skin, GI, and renal and cardiac systems

“hurts to pee, see, and bend my knees”

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7
Q

describe the multi joint inflammation that occurs with spondy conditions

A

more than 30 min of pain after prolonged position

improved pain with easy movement

axial skeleton inflammation

asymmetric/unilateral involvement less likely (usually with smaller joints/at entheses)

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8
Q

clinical manifestations of DISH

A

may be asymptomatic
usually discovered from x-rays
back pain and stiffness
age appropriate spinal mobility
may not have functional limits
possible neuro if stenosis develops

URGENT REFERRAL

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9
Q

What might you see on imaging from DISH

A

ossifications along antyerolateral aspect in at least 4 successive vertebral bodies

no disc/joint degeneration

no fusion of factes

no osteoporosis

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10
Q

what is prostate cancer

A

prostate = reproductive gland below the bladder that aids in sperm function

unknown etiology

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11
Q

risk factots for prostate cancer

A

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

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12
Q

incidence of prostate cancer

A

only males
usually over 65
2nd most common cancer/death
African Americans > European Americans

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13
Q

pathogenesis of prostate cancer

A

disorganized gland cells infiltrate prostate

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14
Q

clinical S&S of prostate cancer

A

cancer S&S
often asymptomatic in early stages
lumbopelvic P!
primary tumor = bladder and sexual dysfunction
more common metastatic tumor

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15
Q

important questions to ask if a pt may be in the expected group for prostate cancer

A

always check bowel and bladder status

inquire about prostate specific antigen (PSA) screening yearly after age of 55

pelvic floor muscle training (PFMT) = over all benefit for bladder dysfunction

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16
Q

referral for suspected prostate cancer

A

URGENT

17
Q

what is nephrolithiasis

A

aka kidney stones or renal calculi

can get them in kidneys, ureters, bladder, and urethra

18
Q

function of urinary system

A

filter fluid from renal blood flow

remove waste

retain essential substances for fluid and contents balance

stimulate RBC production

regulate BP

convert vitamin D to active form

19
Q

etiology/risk factors for kidney stones

A

disorders that lead to hyperexcretion of calcium (i.e. hypercalciuria, hyperthyroidism)

not primarily drinking water

obesity

high animal protein

20
Q

incidence/prevalence of nephrolithiasis

A

3rd most common urinary tract disorder behind infections and prostate conditions

21
Q

pathogenesis of nephrolithiasis

A

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

22
Q

clinical manifestations and S&S of kidney stones

A

reffered pain into T10-L1 dermatomes (LBP, flank, and abdomen)

radiating pain into groin

bladder dysfunction/TTP

eventually unrelenting P!

N&V

kidney/urinary infection may be present

23
Q

what is murphy percussion

A

percussion over kidney

used to determine referral

one firm closed fisted percussion over 12th costovertebral angle

WNL = painless

24
Q

referral for kidney stones

A

mostly urgent but sometimes emergent depending on severity

25
Q

function of the pancreas

A

exocrine = secretes enxymes for digestion, converting food/fluid to fuel

endocrine = releases insulin for sugar regulation

26
Q

what is pancreatitis

A

severe inflammation of pancrease

can be acute (reversible) or chronic

27
Q

etiology of pancreatitis

A

chronic alcohol consumption

high triglycerides that render insulin and receptors useless (diabetes)

obesity- contributions from high triglycerides

trauma

genetics

infectious agents

28
Q

pathogenesis of pancreatitis

A

alcohol toxicity to pancreas cells

gallbladder bile refluxes into pancreas causing inflammation and possible fibrosis

29
Q

clinical manifestations of pancreatitis

A

sharp right upper quadrant pain (radiates into thoracolumbar)

worsened with fatty meals/drinking alcohol

pain gets better with knees close to chest

N&V

jaundice/yellow

Grey-Turner-Sign = swollen flanks

Cullen sign = swollen umbilicus

can progress to infection S&S and vital and mental status change

30
Q

PT implications for pancreatitis and referral

A

may lead to scarring in thoracolumbar region and be unmodifiable to JMs

urgent/possibly emergent referral depending on severity

31
Q

what is an abdominal aortic aneurysm

A

weakening of vessel wall

32
Q

incidence/prevalence of abdominal aortic aneurysm

A

aorta = most common site

Males > females

increasing frequency due to aging population

33
Q

risk factors for aortic aneurysm

A

smoking

> 50 years old

male >female

vascular wall diseases (artherosclerosis/collagen disorders = weakened wall)

genetics - family history of AAA

34
Q

etiology of AAA

A

trauma

vascular disease

infection

35
Q

pathogenesis of AAA

A

weakening and loss of elastin in vessel walls

36
Q

What might a pt with AAA tell you

A

Hx
-often asymptomatic/identified accidentally

-most often LBP but possibly abdominal and flank pain especially with activity

-searing, ripping, or tearing back or abdominal pain that stops all activity

37
Q

observation for AAA

A

abdominal heartbeat

38
Q

palpation S&S for AAA

A

non tender palpable mass (>3cm) that pulses, typically just L of midline from umbilicus

bruit with auscultation over aorta is more diagnostic than palpation alone

also absent/diminished pulses everywhere

39
Q

referral for AAA

A

do not want to miss condition

emergency referral

MOST die before going to hospital

ClinMed II (12 decks)

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