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CD 3305 > Module 10 Exam > Flashcards

Module 10 Exam Flashcards

1
Q

Cervicogenic dorsalgia

___% of common dorsal pain is…

Commonly at which spinal levels?

Population?

What sign is typically seen?

Which side would you adjust to?

A

cervicogenic origin (Cloward’s sign)

T2-3, T5-T6

Pain is predominantly in the interscapular area (deep-seated weighted pain), unilateral; sometime bilateral or midline

Female - typists, desk workers

adjust towards PAIN-FREE side

Overcoat

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2
Q

Pain from: Discopathic, osteophytic, DJD, Ligamentous Hypertrophy, hyperactive peripheral receptors…is know as

& TPs are also known as

A

spondylogenic origin

myoneural points

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3
Q

TL Sydrome

__% of back pain was from TL origin

How does it refer pain to the iliac crests, SI joints, lateral thigh (clutes)?

Do does this differ from classic pain of hip OA?

A

40%

o Irritation of the T/L facet joints –> Irritation of cluneal nerves —> Referred pain to iliac crest, SI joint, lateral thigh (glutes specifically)

o **Most reliable pattern for actual hip pain (ie. hip OA) = pain in hip, anteromedial thigh, groin, knee

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4
Q

End feel of joints

springy

hard

normal

bony

EMPTY/HOLLOW*

A
  • Springy end feel – inclusion body (joint mouse, something there to push you back)
  • Hard end feel – osteoarthritis capsular contracture
  • Normal end feel – shoe leather
  • Bony end feel – osteophytes engage
  • Empty/hollow end feel – fracture, infection (empty because there is nothing to stop the motion but pain); best felt in knee or elbow = EXAM QUESTION
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5
Q

According to the JMPT FMS article…

What’s classic FMS vs. pseudo FMS?

What are the three types of pFMS?

A

Classic: sleep dysfunction**, anxiety/depression, CNS chemistry change (migraine, cognition), train injury/trauma, “aching all over”, no response to manual care = decreased pain threshold (aka. central allodynia)

Type 1 pFMS = organic disease

Type 2 pFMS = functional (ie. vitamin/enzyme deficiency, leaky gut, liver dysfunction)

Type 3 pFMS = MSK (myofascial, sclerotongenous)

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6
Q

FMS

Dx of _____________

Demographic

It is non-___3_____

Distinguishing factors

11/18 tender points - why is it not used anymore?

Periarthritis personality?

A

exclusion

females, 20-60 y/o

non-inflammatory/progressive/degenerative

chronic sleep deprivation*, physical/mental trauma (internalized fear/anxiety)

periarthritis personality = passive, dependent, depressed

11/18 was a criteria list for a research study, not meant to be a clinical tool

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7
Q

2 patho-pathways of FMS

A

chronic activation of HPA (stress response)

vigilant arousal state sleep - non restorative/disturbed sleep: alpha wave intrusion on Stage IV (Delta) NREM sleep.

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8
Q

Rheumatoid arthritis

Demographic?

Etiology?

How long is morning stiffness?

A

2.5x more common in F, 40-60s, PERIARTHRITIS PERSONALITY (depressed, dependent, passive)

AI, leaky gut syndrome, genetic (HLA DR4, DR B1, D3), environment, trauma, endocrine, psych

Around 2 hours in the morning

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9
Q

Patho-phys of RA

A

leaky gut (noxious agent) –> AI response –> hyperplasia of synovium (rugae) –> villus hypertrophy –> pannus formation (granulation) –> more proliferation of lyzosomal enzymes –> erosion –> joint damage

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10
Q

Constitutional and other symptoms of RA

A

TENOSYNOVITIS AND EROSION OF C1 + TRANSVERSE LIGAMENT; displacement of C2

fever, WL, fatigue-

Reynaud’s, infection, pericarditis, bursitis, arteritis/venulitis

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11
Q

4 R program for intestinal dysfunction

A
  • Remove pathogenic microflora
  • Replace digestive enzymes
  • Reinoculate desirable microflora
  • Repair/regenerate
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12
Q

What are some natural therapies for RA?

A
  • Glucosamine sulphate and chondroitin.
  • Glucosamine sulphate and chondroitin.
  • Chinese anti-inflammatory herbal preparations.
  • Apitherapy = refined bee venom
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13
Q

MC form of child idiopathic arthritis

Criteria for Dx?

A

 The MC form of childhood arthritis (< 16 y/o), idiopathic

 Persistent arthritis in 1+ for >6 weeks

  • Arthritis = swelling, effusion, limited motion, tenderness, pain on motion, joint warmth
  • Arthralgia does not satisfy the definition of Arthritis
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14
Q

Palindromic rheumatism?

A

TYPE OF RARE ARTHRITIS…difference is that it has no lasting effect on joints. Just flares

Near 50% of PR patients will go into RA.

Palindromic = “to run back”

Episodic attacks of acute, afebrile arthritis and periarthritis (any joint) - increases with childbirth, vigorous exercise, trauma and infection

ST swelling + pea-sized nodules

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15
Q

OA

Morning stiffness?

Tx?

A

<30 mins (less than RA, PMR, FMS)

  • Glucosamine sulphate, chondroitin, collagen II
  • ↓ night shade foods (tomatoes, potatoes, eggplant, peppers)
  • Bromelain and pancreatin between meals
  • Curcumin (volatile oil fraction of tumeric)
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16
Q

Target sites for spinal OA? 4 segment pairs! Exam Q1

A

C5-6
TL
L3-4
L5-S1

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17
Q

Exam Q: Podagra - what this?

Exam Q: what is INTER-CRITICAL PERIOD?

Tophi?

A

 Podagra – “foot trap”: classical onset gout affecting the MTP joint of the great toe (EXAM)

 The period between gouty attacks is termed the “intercritical period” (EXAM!)
• Essential hyperuricemia may occur without gouty attacks (Uric acid levels often remain normal during acute attacks or between attacks)

Tophus/tophi: Monosodium biurate crystals and flakes, cholesterol, calcium, oxalate

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18
Q

According to Engel, what is the one thing to avoid with his gout?

Other dietary recommendations for gout?

A

fructose! (fruit) - fructose’s substrate is still broken down into uric acid later

decrease purine (meats), increase fluids, colchine (herb), NSAIDs (prostagladin synthesis)

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19
Q

Chondrocalcinosis (Pseudogout)

Also known as…

A

CPPD

Definition: intermittent attacks of acute arthritis and x-ray evidence of calcinosis of the articular cartilage

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20
Q

Polymyalgia rheumatica (PMR)

Demographic? Associated gene?

Clinical signs?

Which areas does it affect first?

Lab tests?

Prognosis?

Tx/

A

> 50 y/o, White, female, HLA-DR4 (insidious)

severe morning stiffness (>2 hrs) but there is GELLING

severe depression, trauma

C-spine + shoulder (unliateral)…then L-spine. hips

temporal artery sensitivity** (beaded thickening or decreased pulsation - scalp tenderness, occipo-temporal headache, visual disturbances

High ESR

Self-limiting within 1-10 years; good response to steroids; anything pharm/natural to decrease immune system

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21
Q

T or F: AS is noted by inflammatory gelling in in rest-activity

A

T: Inflammatory gelling occurs with rest and relieved by activity such as a hot shower, stretching, or walking about.

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22
Q

T or F: AS - FL/EX is the first ROM to go

A

F: lateral FL then ROT

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23
Q

What is Jaccoud Syndrome?

A

Seen mostly in Europe – post rheumatic fever and post SLE

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24
Q

Tietze’s Syndrome

A

Rare inflammatory disorder causing chest pain (Costochondritis). Swelling of the Costochondro junction of the upper rib attachment to sternum. Etiology is unknown. This syndrome usually dissipates within one month, occurs before the age of 40 and affects males and females equally

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25
Q

Rheumatic fever (form of reactive arthritis)

What’s the weird quote associated with it?

Which skin lesion?

Myocardium - _____ nodules

Exam: What is the neurological sign associated with it?

Common infection of which microbe?

A

“Licks the joints and bites the heart”

Immunological reaction in joints due to focal infection

maculopapular rash

Aschoff nodules (pin head size), giant cells and histiocytes

Syndeham’s chorea (“St. Vitius Dance”) - a disorder characterized by rapid, uncoordinated jerking movements primarily affecting the face, hands and feet.

Throat swab shows hemolytic streptococcus in 50% of cases

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26
Q

Systematic lupus erythematosus (SLE)

__-__x MC in women

3 types?

A

10-15x!

Discoid: limited to the skin ONLY (rashes on face, neck, scalp)

Systemic: any organ system (joints, lungs, kidneys, blood, etc)
• More severe than discoid form
• Periods of remission and exacerbation

Drug Induced: similar symptoms to systemic lupus
• Hydralazine (HBP)
• Procainamide (irregular heart rhythms)

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27
Q

Dx criteria for SLE

Tx for SLE?

A

4 positive diagnostic criterion supporting lupus and a positive ANA test = positive diagnosis

malar rash, photosensitivity, oral ulcers, arthritis, renal disorder, arthritis

positive LE prep test and
anti-ANA

Tx: prednisone (corticosteroid)

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28
Q

5 common presenting symptoms of GU conditions

A

flank/back, abdominal pain, discharge, WL, fever

urine (frequency, urgency, burning, hesitancy, nocturia, strain)

CES - retention of urine = ER!!

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29
Q

T or F: Gross, painless hematuria in adults is bladder cancer until proven otherwise

A

T

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30
Q

Meaning behind timing of hematuria

Initial
Terminal
Total

A
  • Initial: urethra (anterior)
  • Terminal: bladder neck and prostatic urethra
  • Total: bladder and/or above
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31
Q

Nephrolithiasis

Demographic?

Location of stones?

A

M, 30-50 y/o

Associated with gout, UTI, HPT (hyper-Ca)

renal calyx, pelvi, ureter

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32
Q

MC type of kidney stone in adults

MC type of stone in children?

A

Calcium oxalate = 70%

Brown/black envelope shape (acidic urine)

Cysteine - hexagonal shape

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33
Q

Shapes of these stones?

calcium phosphate (10%)

struvite (10%)

uric acid

A

porcupine

coffin (alkaline urine)

yellow diamond (will show up on CT, but not x-ray)

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34
Q

Which stone?

High serum Ca

Low urine pH

high urine pH

A

Ca OX, Ca Phos

uric acid (yellow diamond)

struvite (coffin)

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35
Q

T or F: 90% of stones are radiolucent

A

F: radio-opaque

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36
Q

T or F: Uric acid stones are radio-opaque

A
  • Uric acid stones are not going to be seen on x-ray but you can see them on CT
  • Indinavir and Atazanavir stones are radiolucent in body x-ray and CT
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37
Q

Stones that

A

<5 mm

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38
Q

Best recommendations for kidney stones?

A

FLUID INTAKE (>2 L/day)

reduce protein, OX, Na, sucrose/fructose

if its small (<2 cm) they’ll blast it with ESWL. if it’s >2 cm (skin incision) via PCNL

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39
Q

MC microbe of UTI

A

E. coli

F > M

40
Q

Sx of UTI

A 
	Frequency (going to the washroom more than usual)
	Urgency (Intense desire to urinate)
	Dysuria (Painful urination) 
	Burning micturition
	Hesitancy (Taking longer to start peeing)
	Post-void dribbling
	Suprapubic pain
	Hematuria
	Foul-smelling urine
41
Q

Recurrent/chronic cystitis is characterized as >__UTIs/year

What is interstitial cystitis then?

A

3

Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a chronic bladder health issue. It is a feeling of pain and pressure in the bladder area. Along with this pain are lower urinary tract symptoms which have lasted for more than 6 weeks, without having an infection or other clear causes.

42
Q

Pyelonephritis

Defined as?

Agent?

4 big clinical features?

List some causes

A

infection of the renal parenchyma

Causative microorganisms: Enterococcus faecalis, S. aureus, S. saphrophyticus, E. coli,

Fever, chills, nausea/vomiting, CVA tenderness/flank pain

stones, DM, catheters, prostatic obstruction

43
Q

T or F: Asymptomatic bacteriuria requires treatment only in pregnancy.

A

T: Asymptomatic bacteriuria should be treated in pregnancy due to increased risk of pyelonephritis and preterm labor.

44
Q

Hydronephrosis

Defined as?

A

dilation of the renal pelvis/calyx due to impairment of flow

45
Q

4 types of urinary incontinence

A

Stress - involuntary leak with sudden increase in IAP (laugh, sneeze, cough), no night Sx, no urgency/frequency…think of Mama D

Urgency - leakage preceded by strong/sudden URGE to pee. detrusor muscle overactivity

Mixed - stress + urgency

Overflow - constant drippling, they can never feel empty; associated with a retention problem (underactive detrusor muscle)

46
Q

2 features of acute kidney injury (previously aka acute renal failure)

A

azotemia

abnormal urine volume

47
Q

Analgesic nephropahties

  1. Vasomotor AKI
  2. Acute intersitial nephritis (AIN)
  3. Chronic intersitial nephritis (CIN)
  4. Acute Tubular Necrosis (ATN)
A
  1. Vasomotor AKI - NSAIDs
  2. Acute intersitial nephritis (AIN) - Fenoprofen (60%), ibuprofen, naproxen
  3. Chronic intersitial nephritis (CIN) - phenacetin or acetaminophen
  4. Acute Tubular Necrosis (ATN) - acetaminophen
48
Q

Acute Tubular Necrosis (ATN) urinalysis shows…

A

muddy brown casts (dead tubular cells)

49
Q

4 clinical features of chronic kidney failure

A

HTN, electrolytes/pH disorders, uremia, anemia

50
Q

Hereditary forms seen with __ ____-_______ syndrome and hereditary papillary renal carcinoma

A

Von Hippel-Lindau (VHL) syndrome

Manifested by retinal angiomas, central nervous system hemangiomas and ccRCC.

51
Q

“Too late triad” in RCC

A

Classic “too late triad” found in 10-15%

Gross hematuria 50%

Flank pain <50% - renal capsular distension

Palpable mass <30%

52
Q

Main modifiable RF for bladder cancer is…

MC form of bladder cancer

A

smoking!

Urothelial carcinoma (UC) >90%

53
Q

Benign prostatic hyperplasia (BPH)

A

DRE (prostate is smooth, rubbery, and symmetrically enlarged)

> 10 ng/ml of PSA = cancer

54
Q

Prostate cancer DRE

A

hard irregular asymettrical nodule

55
Q

MC etiology of Acute Bacterial Prostatitis

A

ascending urethral infection (80% is E. coli)

chronic version of this is just recurrent UTI via same organism

56
Q

Common RF for GI conditions

A

Hx of travel, Weight loss, Anemia, heme positive school, dysphagia (difficulty swallowing), odynophagia (pain with swallowing), GERD, >50 y/o

57
Q

Barret’s esophagus

MC cause?

Demographic?

A

Definition, Metaplasia of normal squamous esophageal epithelium to abnormal columnar epithelium

Chronic GERD

M, >50 y/o, white, smokers, OB

associated with adenocarcinomas

58
Q

Questions for dysphagia?

A
  • Difficulty in starting swallowing?
  • Associated symptoms? (regurgitation, Change in voice pitch, weight loss)
  • Solids, liquids, or both?
  • Intermittent or progressive?
  • History of heartburn?
  • Change in eating habits/diet?
59
Q

Esophageal Diverticula

3 classifications

A

Outpouchings of one or more layers of the esophageal tract.

Pharyngoesophageal (Zenker’s) diverticulum

Mid-esophageal diverticulum

Just proximal to LES (pulsatile type)

60
Q

6 “S” of esophageal carcomas

A 
o	Smoking
o	Spirits (alcohol)
o	Seeds (betel nut)
o	Scalding (hot liquid)
o	Strictures
o	Sack (diverticula)
61
Q

90% of esophageal hernias are which type?

Risk factors?

A

sliding hiatus hernia (herniation of both stomach and gastroesophageal (GE) junction into thorax

increase IAP, age, smoking

62
Q

Duodenal ulcers (6 classical features)

A

 Epigastric pain, burning, may be localized to tip of xiphoid or radiating to the mid back (T5-T8)
 Develops 1-3 h after meals (So, food intake relieves the pain)
 Relieved by eating and antacids
 Interrupts sleep
 Periodicity (occurs in clusters over week with subsequent periods of remission)

63
Q

When you think of measuring gastrin, you think off…

A

Zollinger-Ellison syndrome

Gastrinoma, tumor of the pancreas or duodenum that can cause increase production of gastrin

64
Q

Complications of peptic ulcers

A

perforated ulcer, posterior penetration, hemorrhage, gastric outlet obstruction

65
Q

5th MC common cancer in the world…although incidence has went down by 2/3 in the past 50 years…

A

gastric adenocarcinoma

66
Q

Gastric adenocarcinoma - RFs

A 
	Age > 70
	Chronic gastritis
	H. pylori infection
	Blood type A
	Smoking
	Smoked food
	Gastric adenomatous polyps
67
Q

All are signs off…

 Virchow’s node: enlarged left supraclavicular node
 Blumer’s shelf: mass in pouch of rectouterine pouch
 Krukenberg tumor: metastases to ovary
 Sister Mary Joseph’s nodule: periumbilical lesion
• Seen in: gastric, colon, pancreatic, gynecological cancers
 Irish’s node: left axillary nodes

A

Metastatic Gastric Carcinoma

68
Q

MC presentation of celiac disease is….

Other signs?

A

IRON DEFICIENCY ANEMIA

cool if off gluten-free diet

Dermatitis herpetiformis (DH) is a chronic autoimmune blistering skin condition, characterised by blisters filled with a watery fluid that is intensely itchy.

69
Q

Serological tests for celiac disease

Which other test would you do?

A

Serum anti-tTG IgA (Anti-tissue Transglutaminase) and antiendomesial antibodies

Small bowel mucosal (mostly duodenum) biopsy is diagnostic

70
Q

IBS

Crohn’s - gum to bum; what’s the common appearance? Blood or non-bloody diarrhea?

A

Crohn’s = cobblestone (ileum + ascending colon); NO BLOOD

71
Q

IBS

Ulcerative colitis (UC)

Risk is less in….

hallmark sign?

2 complications?

A

COLON to bum (cecum always involved)

less in smokers

RECTAL BLEEDING

no bloody stool…until later

increased colorectal cancer and TOXIC MEGACOLIN (>6 cm diameter)

72
Q

Irritable bowel syndrome

Dx of ______

A

idiopathic - pain relieved by bowel movement

F>M

Dx of exclusion

73
Q

Appendicitis

Demographic?

Classic pattern of pain?

A

6% of population, M>F (most are between age 5-35 y/o)

MCBURNEY’S point

 Abdominal pain (classic pattern: pain initially periumbilical; constant, dull, poorly localized, then well localized pain over McBurney’s point)
 Flexed knee and hip in severe pain

74
Q

2nd MC cause of cancer death….

A

Colorectal carcinoma (CRC)

75
Q

What is pain (definition)?

A

unpleasant sensory/emotional experience associated with actual OR POTENTIAL tissue damage, or described in terms of such damage

76
Q

Difference between pain and nociception

A

nociception - objective, measurable - afferent impulses from periphery to CNS in response to noxious or harmful stimuli

pain is SUBJECTIVE EXPERIENCE. It is PERCEIVED. Pain is motivational (leading to changes in behaviour). Pain is a cognitive organized

77
Q

T or F: pain predicts behaviour, nociception does not

A

T

78
Q

Wall (1979) - he said pain is not protective because pain comes back even if the lesion is healed…so…

A

he argues pain is a CENTRALLY driven/mediated response rather than peripheral only (like hunger and thirst)

PAIN IS A NEED-STATE OR BODY-STATE –> which can predict behaviour

Once SAFETY is determined, normal functioning can occur

79
Q

Bidirectional control of the midline system is regulated by what neurons?

A

ON or OFF - recruited by HIGHER brain structures

80
Q

Woolf (2010) says pain is like a memory…what does that mean?

A

features of central sensitization involves the memory centers (insula, anterior cingulate cortex). ie. showing someone something scary and nociceptors fire

81
Q

Woolf (2010) says central sensitization is not just the decreasing of thresholds but also…

A

dysfunction of the inhibitory pathways too (of the interneurons around the dorsal horn)

82
Q

What is the “spill over effect” according to Woolf (2010)?

A

if interneurons are not working, you are going to get activation of neurons that were not meant to be activated in the first place

83
Q

Allodynia vs. hyperalgesia

A

allodynia - pain to non-painful stimuli

hyperalgesia - increase pain to a mildly painful stimuli

84
Q

Central sensitization & co-morbidity of sleep disturbance

Pathway

A

STT –> RF (reticular formation)

if you have pain, RF is going to be stimulated - not allowing you to sleep

85
Q

What’s happening at each pain stage?

Acute
Subacute
Persistent

A

acute - inflammation
subacute - rebuilding - fiber production
persistent - strengthening/conditioning

86
Q

T or F: neuropathic pain is pain from nerve damage itself

A

T

87
Q

Are are pain-avoidance behaviours self rewarding?

Butler & Moseley - what are neural tags?

A

by minimizing incidents of pain intensity - by checking in with the pain to see if it’s there…it’s like practicing pain!

self-fulfilling prophecy

tags = the neural pathways we check when we avoid pain - practicing the pain. This causes synaptic TAGGING –> protein expression and linking/strengthening of a pathway

88
Q

Why do we need to exercises with caution in pain patients?

A

DOMS can mimic their pain.

89
Q

Chronic pain acceptance questionnaire follows 2 domains….

A

pain willingness (recognition that avoidance and control are often unworkable methods to adapting to chronic pain)

activity engagement (regardless of pain)

90
Q

George Engel (1977) psychiatrist who created the…

A

BPS model of heatlh

91
Q

Why is Waddell’s test misunderstood?

5 categories with 8 potential signs

A

not a malignering test. it is a test for AMPLIFICATION (BPS issues)

1) regional neuro disturbances (neuro/sensory)
2) distraction - seated SLR
3) overreaction - screaming, grimacing,
4) stimulation - axial loading –> low back pain
5) tenderness with skin pinch

positive if 3/5 (2/5 is still normal!)

92
Q

Meade Study

DCs vs. PTs in hospital

A

chiro improved pain/disability observable 3 years later compared to hospital PTs

this simply shows that we are doing something DIFFERENT

93
Q

Haas (2004) - Dosage of Chiro in LBP

T or F: More SMT in weeks of care had more impact (on functional disability and pain)

Conclusion on dosage: About ___% of pLBP or episode or reccurent pLBP did do well with a short course

A

T - in order words, a short period of concentrated visits yields better results. caps off around 12 weeks

75%

94
Q

T or F: supportive care is not maintenence care.

A

T

supportive care = PERMANENT impairment…they cannot return to their pre-injury status

95
Q

What is behaviour activation (BA)? Mostly used for?

A

CBT technique - patient identifies meaningful activities.

They try to do more of it while decreasing the time spent doing stressful or unpleasant activities

Depression - but parallels with pain!

Big part of CBT is getting the person to realize that what they are doing may not be working and they need to try another approach or perspective

CD 3305 (1 decks)

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