pathologies related to ankle - exam 3 Flashcards
what is diabetes?
chronic systemic disorder characterized by hyperglycemia and abnormal metabolism
what is type I diabetes
- auto-immunity affecting the ______ that produces ______
- deficiency of ______
auto-immunity affecting the pancreas that produces insulin
deficiency of insulin production and secretion
what is type II diabetes
- excessive dietary _______ and ____ limits effect of insulin
- may be influenced by _______
- sugar and other simple carbs
- auto-immunity
what does insulin do?
released from the pancreas
lowers blood sugar
stores fat
incidence/prevalence of diabetes
- _______ of americans are pre-diabetic
- ______ americans have diabetes
- most common _______ disorder
- type _____ more common
1/3
1/10
endocrine/metabolic
II
Type I diabetes risk factor
presence of type I diabetes in first-degree relative
type II diabetes risk factors
family hx
ethnic origin
obesity
increasing age
physical inactivity
HTN
smoking
other contributers to diabetes
SAD
>/= 2 hours of screen time/day as part of sedentary lifestyle
daily carbonated beverage
fast food > 2x/week
unmanaged stress and lack of regular sleep
pathogenesis of type I diabetes
inability to produce and secrete adequate insulin to use glucose
pathogenesis of type II diabetes
- inadequate response of __
- increases:
- as cycle continues,
- _____ production stops
inadequate response of insulin receptors to insulin
increase: sugars, insulin, fat storage/inflammation
as the cycle continues, you limit the effect of insulin so body makes more insulin
insulin production stops –> obesity/diabetes develop
cardinal S&S of both types of diabetes
frequent urination (polyuria)
dry mouth
extreme thirst (polydipsia)
decreased skin turgor
blurry vision due to sugar damaging vessels
weakness/fatigue
excessive hunger
what are the sensory neuropathies that diabetes can progress to
- non-segmental paresthesia and hyposensitivity or numbness of involved peripheral n.
- joint destruction because repeated microtrauma is not felt (charcot foot)
- less aware of a heart attack they are already more prone to
what is the motor neuropathy diabetes can progress to?
weakness of mm. innervated by the involved peripheral n.
what is the autonomic neuropathies diabetes can progress to
affects function of multiple systems, particularly cardiovascular system
- diminished pulses
- necrosis
- poor healing
- stroke
- cardiac dz
other severe complications that could come from diabetes are:
- leading cause of ____ and _____
- _____ dysfunction leading to _______ (aka type III diabetes)
- kidney dz and blindness
- cognitive; Alzheimer’s
auto-immunity occurs with type _____
metabolic acidosis may occur with type _____
1
1
signs of diabetes:
- observation
charcot foot
dry mouth
cognitive decline
fruity and long deep breaths with TYPE I
signs of diabetes:
- scan & biomechanical exam
- neuro
- palpation
- age related joint change in 1/2 diabetics
- diminished sensation - peripheral n. pattern. assess 2 pt discrimination and monofilament sensation
(+) dural mobility
weaknesses of peripheral n
myotomes WNL (not affecting spinal n.) - palpation of diminished pulses
referral for diabetes
urgent
with diabetes, due to persistent inflammation and impaired circulation we see a higher prevalence of:
carpal tunnel syndrome
Dupuytren’s contracture
trigger finger
adhesive capsulitis
HIGHEST: DISH
due to increase in osteoclastic activity with diabetes, _____ develops in first 5 years of dx
osteoporosis
which type of diabetes can be controlled and reversed with proper diet, exercise, and/or medications
type II
parameters for exercise with diabetes
check with MD initally
no restrictions if glucose levels monitored and managed well
3 10 minute bouts better than 1 30 minute bout (can regulate sugar more frequently)
how long should a pt with diabetes wait to exercise after a meal
1-2 hours so you don’t decrease sugar levels too quickly
diabetes and exercise:
- may need to _______ insulin prior to exercise
- may need _______ carbs after exercise
- decrease
- extra
what should you educate a patient with diabetes on?
wear accommodating shoes and socks
examine feet regularly for skin breakdown
avoid alcohol and cortisone shots, high sugars in both
> ___/5 of these indicate metabolic syndrome.
diabetes, HTN, high triglycerides, low HDL and being overweight
2
what is gout
metabolic disorder with elevated levels of uric acid and deposition of urate crystals
_____ is most common site for gout
gout is the most common ________ in US
gout primarily in __________ (age & gender)
1st MTP
crystallopathy
middle-aged males
risk factors of gout
family hx
decreased renal function
conditions increasing uric acid production
conditions limiting excretion of uric acid
high fructose of SAD
high nitrogen in organ meats, trout, shellfish, sardines
primary cause of gout
secondary cause of gout
- genetic
- another disorder
idiopathic
pathogenesis of gout:
- uric acid forms from breaking down ______
- kidneys unable to process _______ amount of uric acid
- so _______ uric acid remains in circulation
- sparks an inflammatory response leading to ________(2)
- cellular waste in bloodstream
- higher
- MORE
- necrosis of original tissue and proliferation of fibrous secondary tissue
how long until symptoms of gout usually develop?
~10-20 years of hyperuricemia
S&S of gout
monoarticular (one joint)
sudden onset of severe joint pain, often at night or morning
episodic with increasing frequency and severity
may develop cellulitis or infection
may have constitutional symptoms
PT implications on gout
education on causes and risk factors
patients often develop subsequent orthopedic conditions in and around gouty area
signs of gout:
- observation
- scan and biomechanical findings
- redness, swelling, warmth, possible fever
- like age related joint changes
referral for gout
urgent
what is osteomyelitis
inflammation of bone due to microorganism
destructive infection
prevalence of osteomyelitis
- uncommon in ____
- most common in _____ and _____ bones followed by tibia and femur
- may occur in ____
- wealthier countries
- tarsal and metatarsal bones
- vertebra
risk factors of osteomyelitis
immunosuppression
chronic illness like diabetes
IV drug use
joint replacement
pathogenesis of osteomyelitis
poorly understood
microorganisms, staph
preferentially binds to cartilage
metaphysis of bone is very porous –> spreads quickly
S&S of osteomyelitis
gradual onset of deep and achy P!/stiffness
infection S&S
localaized and progressive P! that limits motion and WBing
may develop constitutional symptoms
signs of osteomyelitis
- observation
- scan and biomechanical findings
- asymmetrical gait, red and swollen, warmth, possibly fever
- like age related joint changes
referral for osteomyelitis
urgent
where is osteochondritis dissecans most common?
medial femoral condyle and talus
S&S of osteochondritis dissecans in ankle
S&S of hypermobility/instability of involved ligament but with persistent age related joint like changes
scan findings of osteochondritis dissecans
- ROM
- resisted
- stress tests
- limited and painful, particularly with DF
- weak and painful, part. end range DF
- compression likely (+)
biomechanical exam findings of osteochondritis dissecans
- stability tests
- palpation
- (+)
- TTP over talar dome
referral for osteochondritis dissecans
urgent
