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Medical Conditions 2 > Musculoskeletal - medical disorders > Flashcards

Musculoskeletal - medical disorders Flashcards

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USMLE® Step 1 flashcards
1
Q

Rheumatic disease

A
  • systemic
  • 100 different types with 10 categories
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2
Q

Rheumatic diseases: pathogenesis

A
  • periods of exacerbations and remissions
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3
Q

Rheumatic diseases: clinical manifestations

A
  • joint pain
  • rash
  • fever
  • diarrhea
  • scleritis
  • neuritis
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4
Q

Rheumatic diseases: medical management

A
  • treatment varies over time (esp with exacerbations and remission)
  • requires consultation with or referral to physician
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5
Q

Osteoarthritis

A
  • slowly evolving articular disease that originates in the cartilage and affects underlying bone, soft tissue, and synovial fluid
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6
Q

Osteoarthritis: risk factors

A
  • Genetics
  • participation in occpations and sports the have prolonged stresses on joints
  • hypermbility and hypomobility
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7
Q

Osteoarthritis: pathogenesis

A
  • function of condrocytes are affected with articular cartilage causing cell death
  • synovial lining secretes excessive synovial fluid
  • chondrocytes do no contiune to make collagen and articular cartilage wears down
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8
Q

Osteoarthritis: clinical manifestations

A
  • bony enlargemetn
  • limited ROM
  • crepitus with motion
  • tenderness with pressure
  • joint effusion
  • malalignment/joint deformity
  • stiffess for a short duration (morning)
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9
Q

Osteoarthritis: diagnosis

A
  • history
  • radiological findings
  • physical examination
  • lab tests
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10
Q

Osteoarthritis: prevention/treatment

A
  • prevent joint injuries, healthy lifestyle and exercise
  • treatment: education, weight loss, exercise, orthotics, braces, meds, complentary therapy, surgery
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11
Q

Osteoarthritis: pharmcotherapy

A
  • topical capsaician, glucosamine/chondroitin, NSAIDs, and Cox-2 inhibitors
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12
Q

RA:
- what is it
- symptoms

A
  • chronic systemic inflammatory disease
  • symetric simultaneous joint distribution
  • can affect any joint but especially UE
  • inflammation almost always present
  • prolonged morning stiffness more than1 hr
  • systemic presentation with constitutional symptoms: fatigue, malaise, weight loss, fever
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13
Q

RA treatment:

A
  • reduce signs and symptoms to a state of remission
  • meds: analgesics, NSAIDs, corticosteriods, disease modifying anti-RH drugs, cytokine inhibtors, lymphocyte inhibitors,
  • complementary therapy: acupuncture, autogenic training, fish and plant oils
  • surgery: synovectimy to reduce pain and joint damage, total joint replacements, tenosynovectomy of the hand
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14
Q

Juvenile idiopathic arthritis: classifications

A
  • pauciarticular
  • polyarticular
  • systemic
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15
Q

Pauicarticular JIA

A
  • Juvenile idiopathic arthritis
  • knees, elbows, wrist and ankles
  • can have a leg length discrepency
  • girls>boys
  • less than 5 joints are involved

classification based on how may joints are involved, girls>boys and may see leg length discrepency

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16
Q

Polyarticular JIA

A
  • affects five or more joints
  • including large and small joints
  • joint involvement is symetrical and is similar to the adult RA
  • subtypes: presence of Rheumatoid factor or absence of Rheumatoid factor
  • similar to adult RA
  • RF+ = affects eye, hands or feet
  • RF- = affects the spine
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17
Q

Systemic JIA

A
  • involvement of any number of joints
  • boy=girls
  • most extraarticular manifestations
  • fever, chills and intermittently rash on thighs and chest
  • inflammed joints and chronic destructive arthitis
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18
Q

Psoriasis JIA

A
  • inclusion of joint swelling along the skin
  • redness, irritation and scaling
  • treatment with aggressive immunosuppressives
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19
Q

Stills disease clincal manifestations

A
  • Systemic JIA
  • fever
  • rash
  • lymphadenopathy
  • polyarthritis
  • pleuritis
  • peptic ulcer disease
  • hepatitis
  • anemia
  • anorxia
  • weight loss
  • polyarthritis,polyarthralgias
  • myalgia/myositis
  • tenosynovitis
  • skletela growth disturbances
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20
Q

JIA: medical management

Dx, TX,

A

DX:

  • history
  • physical exam
  • labs for inflammation and antinuclear antibodies
  • rheumatoid factor and sometimes HLA-B27

TX:

  • pharmacotherapy: immunosupressives, DMARDs and biologic agents such as TNF inhibitors, infiximab
  • physical therapy
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21
Q

Spondyloarthropathies

what is it and incidence/risk factors

A
  • chronic inflammation of axial skeleton and SI joints
  • asymmetric involvement of small number of peripheral joints
  • young males most commonly
  • familial predisposition
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22
Q

Spondyloarthropathies

Signs and symptoms

A
  • inflammation at sites of ligament, tendon, and fascial insertion into bone
  • seronegativity for Rheumatoid factor but assoicated with histocompatibility antigens, including HLA-B27
  • extraarticular involvement of eyes, skin, gentiourinary tract, cardiac system
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23
Q

Ankylosing spondlitis

Overview and incidence

A
  • chronic inflammation that over time causes the spine to fuse
  • fuses posteriorly
  • 1/3 asymmetrical involvement
  • 0.1-2% of US population
  • higher in whites
  • 15-30 years old onset
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24
Q

Ankylosing spondlitis: risk factors

A
  • genetic or environmental link HLA-B27 positive
  • more prevalent in males
  • less severe in females
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25
Q

Ankylosing spondlitis

Pathogenesis

A
  • chronic inflammation at sites of attachment
  • disruption of the ligamentous-osseous junction >ossification
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26
Q

Clinical manifestations of

Ankylosing spondlitis

A
  • low back, buttock, or hip pain and stiffness
  • insidious onset
  • lasting for at least 3 months
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27
Q

Ankylosing spondlitis

medical management

DX/TX

A
  • DX: history, physical exam, radiography, and lab tests
  • Tx: pharmacotherapy: NSAIDs, DMARDS, TNF- alpha antagonistsor
  • TX: surgery: remove osteophytes or spinal fusion
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28
Q

Implications for PT with Ankylosing spondlitis

A
  • watch for signs and symptoms of systemic diseases
  • exercise: consistency for remodeling and alignment and proper prescription
  • outcome measures
  • positioning - fuses in the best position
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29
Q

Diffuse Idiopathic Hyperostosis

A
  • idiopathic variant of OA
  • ossification of ligaments anteriorly
  • thoracic spine
  • women>men
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30
Q

Diffuse Idiopathic Hyperostosis: risk factors/pathogenesis

A
  • disease that produce endothelial cell damage (HTN, CAD, DM< AS, metabolic)
  • ossification at insertions anteriorly (typically thoracic spine but can affect hip/knee)
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31
Q

Clinical manifestations: Diffuse Idiopathic Hyperostosis

A
  • dull pain and stiffness
  • hoarseness
  • stridor/snoring
  • dysphagia (voice)
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32
Q

medical management: Diffuse Idiopathic Hyperostosis

A
  • DX: radiographic findings (4 vertebrae fusions), rhematoid workup

TX:

  • pharmacotherapy: NSAIDs
  • surgical: removal of osteophytes
  • PT exercise: gentle ROM, STM, dont over stretch at the insertions
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33
Q

Typical MSK infections

A
  • necrotizing fasciitis
  • streptococcal myositis
  • soft tissue infeciton leading to gangrene
  • cellulitis
34
Q

Osteomyelitis

A
  • inflammation of the bone caused by an infectious organsm such as strep
  • common areas: spine, pelvis, extremities
35
Q

Osteomyelitis: incidence

A
  • children> adults, boys>girls
  • acute: children, older adults, IV drug users
  • Chronic: adults, immunocompromised
  • exogenous Osteomyelitis: direct bone exposure
  • hematogenous Osteomyelitis: preexisting infecitons
36
Q

Congential states associated with MSK infections

A
  • chronic granulomatous disease: hemophilia, hypogammaglobulinemia, sick cell disease
37
Q

Acquired states associated with MSK infections

A
  • DM
  • hematologic malignancy
  • HIV infection
  • pharmocologic immunosuppression (organ transplant, collagen-vascular diseases)
  • uremia
  • myelopathy
  • alcoholism
  • malnutrition
38
Q

Pathogenesis: Osteomyelitis

A
  • acute infection may develop in the metaphysis of long bones
  • infecting organism, personal immune status plays a role
  • intial infection
  • the bacteria reaches the metaphysis through nutrient artery
  • bacterial growth results in bone desctruction and abcess formation
  • abcess cavity and pus spreads between trabeculae into medulla through the cartilage into the joint
39
Q

Clinical manifestations

MSK infections

osteomyellitis

A

Adults:

  • back pain –described as deep and constant, increases with WB in spine in LE
  • systemic infection
  • fever
  • spine pain is intermittent or constant, throbbing, radiculopathy, myopathy, paralysis, antalgic gait

Children:

  • intense pain
  • high fever
  • edema, erythema, tenderness
  • joint pain
  • diminished function
40
Q

Medical managemetn of osteomyellitis

Prevention, screening, diagnosis, treatmnet, prognosis

A
  • prevention: education/nutrition
  • screening: hx/review of systems
  • diagnosis: X-ray, MRI, CT, bone scan, blood tests, cultures (drainage)
  • treatment: IV antibiotics, surgical debridement
  • prognosis: good if caught early
  • chronic osteomyelitis has poort prognosis and higher risk of amputation
41
Q

Implications for PT

when treating patients with osteomyelitis

A
  • history and screening
  • wound care
  • precautions with WB
  • prevent complications in other joints and tissue
  • external fixation devicies often get infected
  • if there is an infection do not move that much as this can cause infection to spread
42
Q

Infections of prostheses and implants

incidence

A
  • 2/3 of prosthetic joint infections occur within 1st year
  • staph typicall causes
  • acute infections: perioperative, hematogenous, contiuous (around structures)
43
Q

Infections of protheses and implants: pathogenesis

A
  • local
  • prosthetic implants
44
Q

Infections of protheses and implants: clinical manifestations

A
  • persistent joint pain –pain should calm down with healing
  • edema, hematoma, tenderness, fever
  • prosthetic lossening – may complain of slipping, rubbing, or hearing a cluck
45
Q

Infections of protheses and implants prevention/screening

A
  • prevention: sterilization and infection control cover in the shower
  • screening: history and review of systems
46
Q

Infections of protheses and implants: diagnosis

A
  • differentiate mechanical from aseptic
  • aspiration of joint fluid and culture
  • blood tests, cultures
  • US< radiographs, bone scane, CT
47
Q

Infections of protheses and implants

Treatment

A
  • use of microbial prophylaxia for anyone undergoing joint replacements
  • surgical removal/replacement, debridement
  • antimicrobials, antibiotics, perioperative, cephalosporins
48
Q

Infections of protheses and implants: implications for the PT

A
  • history/screening: recent and previous surgeries or infecitons
  • inspection of scars or incisions and surrounding tissues
  • if they say they had a recent surgery or infection you want to look and palpate

PT treatment

  • precautions or restricitions in movement or WB
  • wound care
  • prevent complications in surrounding strucutures by limiting movement

movement may mobilize the infection

49
Q
A
50
Q

Spondylodiscitis

Defintion

A
  • infection that affects the vertebra spine components
  • intervertebral discs
51
Q

Spondylodiscitis : incidence

A
  • S. anureus and M. Tuberculosis
  • hematogenous spread
52
Q

Spondylodiscitis

Clincal manifestations

A
  • fever
  • spinal pain not relieved by rest
  • cant get comforable = are you running a fever/malaise etc
  • if back is hurt you cna typically find a position that is comfortable
53
Q

Spondylodiscitis: diagnosis

A
  • blood test- inflammatory markers
  • cultures
  • radiographs, bone scans, MRI
54
Q

Spondylodiscitis

treatment

A
  • bed rest: may be to protect area but will be modified
  • body jacket around spine clamshell that must be when OOB
  • IV antibiotics: banomyocen
  • Surgery: debridement
55
Q

Spondylodiscitis

Prognosis

A
  • good
  • potential for vertebral collapse, kyhposis, bony ankylosis and abscess formation
56
Q

Infectious athritis

Most common locations

A
  • adults: hip/knee
  • children: ankle and elbow
57
Q

Infectious athritis

most common causes

A
  • S. aureus
  • streptococcus pneumoniae
  • kingella kingae
  • neisseria gonorrheae
58
Q

Infectious athritis

Predisposing factors for adults

A
  • immunosupressants or immunodeficiency
  • preexisting arthritis
  • arthrocentesis
  • DM (poorly controlled)
  • Sickle cell disease
  • Alcohol or drug abuse
  • trauma
  • infectious disease
  • chronic renal failure
  • abnormal synovium from rheumatoid or degenerative conditions
59
Q

Bacterial arthritis

A
  • hematogenous spread
  • direct inoculation and penetrating injury
  • direct extension
  • periarticular osteomyelitis
  • contigous soft tissue infection, abscess, cellulitis

most of the time related to an invasive procedure

60
Q

Infectious athritis

Pathogenesis

A
  • bacterial growth, phagocytosis, synovial reaction, fibrin production, abscess formation, pannus formation, necrosis
61
Q

Infectious athritis

Clinical manifestations

A
  • acute onset joint pain
  • swelling
  • tenderness
  • loss of motion
  • warm joint
  • pus
  • systemic symptoms: fever, chills etc
  • can destroy a joint quickly
  • pericarditis, septic shock
  • pyelonephritis, multi-organ involvement
62
Q

Infectious athritis

Diagnosis

A
  • joint fluid aspiration
  • X-rays, contrast MRI, US
63
Q

Infectious athritis

Treatment

A
  • IV antibiotics in hopsital and then 2-3 weeks with oral
  • corticosteriods
  • aspiration and surgical drainage
64
Q

Infectious athritis

prognosis

A
  • Good if treatment within 5-7 days of onset
  • mortality 10-25%
  • permanent joint disability
  • possible complications - osteomyelitis abscess formation, septicemia
65
Q

Infectious athritis

Implications for the PT

A
  • history and screening: immediate referal
  • post medical managemetn:
  • *joint ROM and WB precautions or restrictions
  • education for signs of infection
  • joint protection adn strengthenign supporting structures*
66
Q

Myositis

A
  • inflammation of muscules
  • dermatomyositis
  • polymyositis
  • inclusion body myositis
  • myositis ossifcans
  • idiopathic inflammatory myopathies
  • rhabdomyolysis
  • pyomyositis
67
Q

Myositis

Most often causes

A
  • S. aureus and parasites
68
Q

Myositis

incidence

A
  • IBM is most common in ages 50+
69
Q

Myositis

Pathogenesis

A
  • intramuscule fiber degeneration
  • severe weakness
70
Q

Myositis

clinical manifestations

A
  • muscule swelling
  • tenderness
  • fever
  • lethargy
  • atrophy
  • weakness
  • necrosis
  • dysphagia
  • cardiomyopathy
71
Q

Myositis

Dx
TX

A
  • DX: history muscle biopsy, EMG< blood tests
  • TX: immunosuppressive therapy and corticosteriods, submaximal exercise
72
Q

Myositis

implications for PT

A
  • history and screening,
  • lipid lower medications
  • may be the first sign of malignancy
  • exercise: submax, limit eccentric activity, avoid overworking
73
Q

Infections of bursae and tendons

Incidence

A
  • hand
  • knee
  • elbow
  • cellulitis>tenosynovitis
74
Q

Infections of bursae and tendons

Clinical manifestations

A
  • localized swelling
  • pain
  • erythema
  • warmth
  • loss of fucntion
75
Q

Infections of bursae and tendons

DX
TX
prognosis

A
  • Dx: aspiration, culture, surgery
  • Tx: antibiotics
  • Prognosis: good if treatmetn started early; potential for complications, necrosis, osteomyeitis
76
Q

Infections of bursae and tendons: implications for PT

A
  • hand specialization
  • wound care
  • splinting - wrist in 30º to 50ºof extension
  • metacarpophalangeal joints 85ºto 90º of flexion and the interphalangeal joints in full extension AROM
77
Q

Skeletal tuberculosis

Incidence/pathogenesis

A
  • 10 million new cases annuall 1.6 million die
  • extrapulmonary TB 2-3 years after primary infection
78
Q

Skeletal tuberculosis

clinical manifestations

A
  • pain and stiffness
  • localized or referred
  • lower thoracic and lumbar
  • elbows or WB joints
  • systemic signs: chills, fever, weight loss
79
Q

Skeletal tuberculosis

Dx:
Tx:

A
  • DX: delayed due to lack of symptoms initially; MRI, CT, X-ray, bone scans, smear culture
  • TX: chemotherapy, surgical decompression
80
Q

Skeletal tuberculosis

implications of PT

A
  • HIstory an screening
  • precautions and PPE - droplet exposure
  • postural drainage and percussion
  • referral for other psychosocial issues
  • long term disability concerns

Medical Conditions 2 (22 decks)

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