Patho Exam 3 Flashcards
herniated disc
rupture of disc causing fluid to leak out and impinge on and irritate nearby nerves.
- decrease in cushioning of vertebral joints
-back pain and limited mobility
- can cause sciatica
risk factors:
- Age 30 to 50 years
- Excess weight
- Regular heavy lifting, bending, and twisting
- previous back problems
- smoking and genetic factors
clinical manifestations:
with abrupt herniation
- nerve root compression
- severe pain
- muscle spasms
with gradual herniation
- slow onset of pain
- weakness or tingling
diagnosis: mobility tests, CT, MRI, or myelography, nerve conduction studies, blood tests
treatment: NSAIDs, Opioids, Antisasmodics, cortisone or corticosterioids, surgery (laminectomy, discectomy, spinal fusion)
herniated disc (tomei)
L4, L5. Butt, hamstrings, quads. Pulposus of the disc (where the irritation is)
- most common age for this is 30-50.
- most of the time, they will need physical therapy to strengthen core muscles.
-usually midback, lower region.
disc degeneration: patient will need surgery for this, physical therapy won’t help.
pregnant women
women who are pregnant can get back pain. She needs to deliver that baby, get rid of the extra weight.
spinal stenosis
narrowing of spinal column
- vertebral bone degeneration with aging.
slow progressive symptoms:
- numbness
- weakness
- cramping
- general pain (may radiate down arm or leg)
diagnosis: medical history and physical examination.
- x ray, MRI, CT scan
- myelography
treatment: NSAIDs, steroid injections (nerve blocks), physical therapy (lumbar brace)
Lordosis (tomei)
- spinal column more concave
- pregnancy or obesity
scoliosis (tomei)
- Lateral curve of spine
- C shaped or S shaped
- Severe scoliosis (rotation of spine, leading to deformities and disability)
risk factors: age 9 to 15 years
- neuromuscular disorder
- family history
types: idiopathic, congenital (incomplete formation or separation of vertebrae), neuromuscular scoliosis
Curve patterns
Dextroscoliosis: right thoracic curve
Kyphoscoliosis: outward and lateral spine curvature
Rotoscoliosis: curvature of vertebral column turned on its axis
Levoconvex
Curvature of spine to the left and thoracolumbar scoliosis
Curvature related to both thoracic and lumbar regions
Sideways curvature
Mild scoliosis: 10 to 20 degrees
Moderate scoliosis: 20 to 40 degrees
Severe scoliosis: over 40 degrees
Structural vs. nonstructural
Structural
Deformities of bones in spinal column
Nonstructural
Poor posture, differences in leg length, tumors, adaptation to pain
Clinical manifestations
Spinal curvature to one side, uneven hips or shoulders
Differences in leg length
Tiredness of spine
Prominent shoulder blade
Rib bump
Complications
Heart and lung problems
Paralysis
Diagnosis
Adam forward bend test
X-ray
MRIs, CT scans, or bone scans
Treatment
Pain management
OTC analgesics, prescription NSAIDs, opioids
Physical therapy (15–25 degrees)
Brace (20–40 degrees)
Spinal fusion surgery (over 40 degrees)
kyphosis
spinal column convex
scoliosis (tomei)
usually screen kids from school.
what are treatments? when do we put a brace on them?
osteoarthritis
- most common form of arthritis
- wear and tear on joints break down cartilage (causes bone to rub on bone)
gender differences:
men: OA in hips, knees, spine
women: OA in hips, knees, hands
risk factors:
- jobs requiring hard labor or repetitive motion
- obesity
- certain medical conditions
classications:
1) idiopathic OA: localized OA affects one or two joints. Generalized OA affects three or more joints.
2) secondary OA:
caused by underlying condition
etiology and pathogenesis: cartilage breaks down, allowing bones to rub against each other.
- bone spurs
- mobility issues
clinical manifestations: mild symptoms that worsen over time. pain associated with joint degeneration.
diagnosis: most common: X- ray.
others: MRI, ultrasound, blood tests, and joint fluids analysis
treatment: cortisone injections, surgery, OTC analgesics
osteoarthritis (tomei)
- wear and tear tissue
- pain that gets worse with activity
- it’s relieved with rest. with rest you can get stiffness
- it is unilateral
rheumatoid arthrisis (RA)
- chronic systemic autoimmune disorder
- most common form of autoimmune arthritis
- cause unknown: various factors may be involved.
pathogenesis: antibodies in RA bind with other proteins and tissues. create immune complexes that cause inflammation. enzymes cause further joint tissue degeneration.
clinical manifestations: joint swelling, stiffness, warmth, tenderness, pain, joint deformation
systemic manifestations: fatigue, anorexia, weight loss, weakness, low-grade fever.
diagnosis: blood tests, anti-cyclic cirtrullinated peptide (CCP) test, examination of synovial fluids
treatment: NSAIDs, low dose oral corticosteroids, intra-articular steroid injection
rheumatoid arthritis (tomei)
- bilateral
- most common in women 40-60.
- mostly in finger, claw like hand.
- its an autoimmune disorder so they have the antibodies for the cyclic citrullated peptides
psoriatic arthritis (tomei)
patients will have a rash
osteopenia
- decrease in bone density
- can lead to fractures.
common causes: chronic eating disorders or issues with metabolism, chemotherapy or glucocorticoids, radiation exposure, caffenated drinks, alcohol
clinical manifestations: none, spontaneous fracture (limited pain)
diagnosis: DEXA scab
treatment: increased calcium and vitamin D intake. increased weight-bearing exercises
osteopenia (tomei)
- degeneration of the bone.
- Lack of vitamin D and calcium.
- patients should decrease their carbonated drink (caffeine, soda) intake.
- patients should take calcium and vitamin D supplements.
- squats, dead lifts, weight bearing exercises.
scoliosis (tomei)
middle age
in school: Nurse, bend over, check spine, check for lyse (this is called the Adam’s Forward Bend Test)
osteoporosis
- most commonly diagnosed metabolic bone disorder
-low bone density due to low intake of nutrients for bone growth or increase in bone resorption due to aging.
primary osteoporosis
- type 1: menopause
- type 2: decreased bone formation from aging
diagnosis: DEXA scan
- may not be diagnosed until fracture occurs
treatment focuses on preventing fractures:
nutritional support, calcium and vitamin D
- exercise
- measures to prevent falls
- medications
paget disease
- metabolic disorder
- causes select bones to overgrow and become week (skull, spine, pelvis, and femur)
etiology and pathogenesis: bone reabsorption faster than bone formation.
pain, enlarged bones, deformed bones.
diagnosis: presence of fracture, X ray, blood tests
fractures
- break in a bone
- direct force or indirect force
risk factors: age.
younger patients: sports-related injuries
older patients: falls and disease
- poor nutrition
- lifestyle habits (dangerous activities)
- could be presence of bone disease
healing of fractures
Indirect healing
Inflammatory stage:
Bleeding causes hematoma
Inflammatory cells degrade debris and bacteria
Reparative stage:
Fibrocartilage formed
Soft callus joins fractured bone
Hard callus develops
Blood vessels form
Remodeling stage:
Lamellar bone replaces woven bone
Union:
Normal healing
Nonunion:
No clinically significant progress toward complete healing for at least 3 months according to x-rays
Delayed union:
Significantly longer than expected healing time
Malunion:
Bone fragments joined in position not anatomically correct
Direct healing
Use of surgical procedure to realign bone
Fractures that benefit from direct healing
Long-term complications
Severely comminuted; threatened vascularity
Surgical procedures
External fixation
Internal fixation
Closed reduction
closed fracture
not something that breaks through the skin
open fracture
bone breaks through the skin and exposed to environment
how long does it take a fracture to heal?
6-8 weeks patient should be able to get movement. Could take a couple of years to get the bone at its full strength. with time, 1-2 years it will regenerate.
internal vs external fixation (tomei)
internal fixation: involves the use of devices internally (under the skin) positioned within the patient’s body.
external fixation: the devices are screwed into fractured bones to exit the skin and are attached to a stabilizing structure outside the body
what if someone in a cast has tingling paralysis when it was put on?
compartment syndrome. nerve damage, it is a medical emergency.
compartment syndrome
edema and swelling cause increased pressure in muscle compartment
- decreased blood flow
- possible muscle and nerve damage
- cycle of continually increasing pressure in limb
- ischemia may cause muscles and nerves to die (limb might need to be amputated)
- most common in lower leg and forearm
prevention: elevation and ice
complications: paralysis, need for amputation, volkmann contracture
complications of fractures
fat embolism syndrome:
- closed long bone or pelvic fractures
- fat emboli becomes trapped in pulmonary and dermal capillaries
- no symptoms in most patients
- large amount of fat released may cause fat embolism
treatment: oxygen administration, mechanical ventilation, prophylactic treatment with corticosteroids and early immobilization of injury
fat embolism (tomei)
major trauma due to leg. rapid short breathing dyspnea, clot can develop to the lungs.
strain and sprain (tomei)
both ice, elevation. Don’t put heat on it for at least 72 hours later.
strain
- overstretching injury to muscle or muscle- tendon unit
- forces muscle to extend beyond capacity, resulting in microscopic tears
- most common sites: lower back and neck
-immediate pain, reduced range of motion (ROM)
- muscle spasms
- edema
- muscle weakness
sprain
- ligaments around joint stretched or torn
- oppositional forces cause ligament to overstretch and tear
- most common site: ankle
- severely hindered ROM
- pop or rip when injury occurs
- bruising, pain, immediate swelling
strain and sprains treatment
- RICE, NSAIDs
- casts, splints, immobilizers, or slings
- surgery for severe injuries
- physical therapy
ACL (tomei)
you will usually tear your meniscus as well; knee will pop.
- don’t need surgery all the time, could heal on its own.
ACL (anterior cruciate ligament)
- one of four major ligaments that connects the femur to the tibia
- injuries occur when stressed, strained, or town
etiology: decelerating while running
- twisting or jumping
pathogenesis:
- tear down middle of ligament
- ligament torn completely from femur
clinical manifestations; intense pain, feeling that knee “popped” and “gave out”, swelling
diagnosis: X- ray and MRI
treatment: ice, elevation, pain medication NSAIDs
- physical therapy
- non-weight bearing until swelling subsides
- surgery if symptoms persist
rotator cuff (tomei)
patient can’t lift their arm above their head. can’t reach the back of their head. need to rest arm, they may need surgery. first 6 weeks, passive movements they can’t be throwing a baseball.
rotator cuff tears
- tendon supporting muscle rips or tears from the bone
causes: fall on shoulder, attempt to break fall with outstretched hand, repeated overhead motions
clinical manifestations: dull ache in joint from microscopic tears, weakness when raising arm, inability to reach behind back
diagnosis: shoulder ROM assessment, X- Ray, Ct scan
treatment: rest, application of cold or heat to area, cortisone injections, surgery
hip fractures (tomei)
worry about avascular necrosis also called osteonecrosis: bone dying on older patient
- reduced blood flow to joint
- bone breakdown occurs faster than replacement
osteomyelitis (tomei)
inflammation of bone usually due to infection. Bone will be very painful, red, worn, swollen, patient may have fever.
osteomyelitis
bone infection
- occurs after penetrating wound, from blood infection, skin breakdown.
- joint replacement and internal fixation surgeries
-bacteria, fungi, parasites, viruses
- bone pain, drainage and ulceration, swelling, redness, warmth, tendernous
- fever with chills, vomiting, lymph node swelling
diagnosis: X ray, bone scan, MRI
treatment, antibiotics, surgery (for extreme ischemia)
know type 1 and type 2 diabetes (tomei)
type 1: patient has no insulin, they need to be put on insulin. could be juvenille too.
type 2: patient could have insulin, but their body doesn’t recognize it. these patients do not need to be put on insulin to survive, they just need to watch their diet. usually older onset, mid 20s and up.
type 1 diabetes
- almost complete lack of insulin secretion
- insulin deficiency considered total or absolute
type 2 diabetes
- relative insulin deficiency
- insulin secretion too low in relation to blood glucose levels
beta and alpha cells in pancreas. who secretes what? what do they do? (tomei)
alpha cells: release glucagon when blood sugar too low
beta cels: release insulin when blood sugar too high
more on diabetes (tomei)
- family history or overweight, diabetes risk increases.
- once you have it, it doesn’t go away, patient has to control it.
- high risk for diabetes: african americans, heavy weight, hispanics
know what normal sugar should be, normal A1C levels too (tomei)
A1C ≥ 6.5%
Symptoms of diabetes plus casual plasma glucose concentration ≥ 200 mg/dL
Fasting plasma glucose ≥ 126 mg/dL
2 hour plasma glucose ≥ 200 mg/dL during an oral glucose tolerance test
goiters (tomei)
little growth on thyroid. can be benign or cancerous.
most common cause: iron deficiency
goiters
- abnormal growth of thyroid gland
- nodular or diffuse
- normal, decreased, or increased thyroid hormone production.
- nontoxic diffuse goiters: simple goiters; no overt hyperthyroidism or hypothyroidism
causes:
worldwide: iodine deficiency.
United States: multinodular goiter, hashimoto thyroiditis, graves disease.
uncommon causes: tumors, thyroiditis
clinical manifestations (if present):
- associated with type of thyroidal dysfunction and growth rate of goiter.
- risks of long- standing goiters: obstruction; sudden increase in size.
diagnosis: physical examination through palpation, neck assessed for masses or cervical adenopathy, biochemical testing
hyperthyroidism (graves disease)
happens when the thyroid gland makes too much thyroid hormone
- hyperthyroidism speeds up the body’s metabolism.
- this can cause many symptoms such as weight loss, hand tremors, and rapid or irregular heartbeat
hypothyroidism (hashimoto thyroiditis)
- a common condition where the thyroid doesn’t create and release enough thyroid hormone into your bloodstream.
- this makes your metabolism slow down
- can make you feel tired, gain weight, and unable to tolerate cold temperatures
hyperthyroidism (tome)
slow, overweight, constipated, eyes buldge out of head.
exophthalmos in a patient with graves disease: this disease causes edema of the far deposits behind the eyes and inflammation of the extraocular muscles. the accumulating pressure forces the eyes outward from their orbits.
^^most commonly caused by thyroid disease
cushings disease (tomei)
striations on belly, swollen face, red face
cushing syndrome
results from chronic exposure to excess glucocorticoids
- develops over period of years, leads to adrenal cortical hyperplasia and excessive production of glucocorticoids
clinical manifestations:
- progressive redistribution of fat (abdomen, face, neck)
- dermatologic: skin atrophy; fragile skin
anxiety
state of apprehension mixed with fear or worry
- real or perceived threat
somatic responses
- palpitations
- sweating
- rapid breathing
- nausea
tyes:
- generalized anxiety disorder (GAD)
- social anxiety disorder (SAD)
- panic disorder
risk factors: genetic, familial, environmental
comorbidities:
- depression
- panic disorder: respiratory disease, vestibular dysfunction, thyroid problems, cardiac disease
anxiety disorders (tomei)
panic disorder: recurrent, unexpected episodes of panic. Palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, feelings of unreality, dying or “going crazy”
avoidance of any situation seen as inescapable or there is no help if attacked
specific phobia: unreasonable or excessive, persistent fear of specific objects or situations
social anxiety disorder: fear generated by social or performance situations with exposure to unfamiliar or scrutiny
generalized anxiety disorder: excessive worry; difficult to control
worry generates restlessness, fatigue, difficulty concentrating, irritability, tension, and sleep disturbance.
pharmacologic and nonpharmacologic treatment of anxiety
pharmacologic:
- SSRIs
- selective norepinephrine reuptake inhibitors (SNRIs)
- benzodiazepines
- combination therapy
nonpharmacologic:
- cognitive- behavioral therapy (CBT)
- exposure therapy
- progressice muscle relaxation
carpel tunnel syndrome (tomei)
tingling in fingers due to median nerve
carpal tunnel an cubital tunnel syndromes
nerve entrapment: neuropathy causing nerve damage and muscle weakness or atrophy
body areas most prone: where nerves pass over rigid areas or through narrow canals
etiology and pathogenesis: repetitive use injury; median nerve compressed by inflammation and swelling of synovial lining of tendon sheaths
clinical manifestations: numbness and tingling of thumb, index finger and lateral ventral surface of middle finger, hand weakness
diagnosis: tinsel test, phalen maneuver, nerve conduction studies with ultrasound
treatment: splinting and application of ice or heat, surgery to enlarge tunnel
carpal tunnel an cubital tunnel syndromes
nerve entrapment: neuropathy causing nerve damage and muscle weakness or atrophy
body areas most prone: where nerves pass over rigid areas or through narrow canals
etiology and pathogenesis: repetitive use injury; median nerve compressed by inflammation and swelling of synovial lining of tendon sheaths
clinical manifestations: numbness and tingling of thumb, index finger and lateral ventral surface of middle finger, hand weakness
diagnosis: tinsel test, phalen maneuver, nerve conduction studies with ultrasound
treatment: splinting and application of ice or heat, surgery to enlarge tunnel
positive phalen test (tomei)
means patient is positive for carpel tunnel syndrome
bursitis (tomei)
inflammation of bursa (enclosed fluid-filled sacs). they are cushions between muscles, tendons, and bony prominences.
results from:
- overuse of joint
- direct trauma to joint
clinical manifestations:
- tenderness of area around
- pain with extension and flexion of joint
- warm, red, swollen, skin over bursa
treatment: rest, compression, elevation, ice (acute inflammation)
thyroid secretes
main hormones it secretes are T3 and T4, but it also secretes calcitonin
c cells in thyroid make and secrete calcitonin
diabetic ketoacidosis
if a patient is in bad shape as a diabetic, they could start to urinate ketones.
