pathologies related to knee - exam 3

Question 1

what is DVT

Answer 1

partial or complete occlusion of a vein by a clot

Question 2

causes of DVT:
conditions involving at least two of the following:

Answer 2

1. venous stasis
2. hypercoagulability
3. damage to the venous wall

Question 3

risk factors of DVT

Answer 3

prior DVT
hx of cancer, CHF, or lupus
major infection, surgery, or trauma
present chemo, immobility, pregnancy
use of oral contraceptives
genetic clotting disorder
> 60 years

Question 4

3rd most common cardiovascular disease

Answer 4

DVT

Question 5

where are DVTs most commonly found

Answer 5

LE deep veins
popliteal, femoral, tibial, peroneal

Question 6

DVT is the most preventable cause of _____
DVT is the most common cause of ______

Answer 6

hospital related death
readmissions and death after THA/TKA

Question 7

pathogenesis of DVT

Answer 7

greater exposure of platelets and clotting factors to damaged venous wall
fibrin, leukocytes, erythrocytes adhere and form thrombus

Question 8

DVT prevention and treatment per MD direction

Answer 8

early and regular exercise
anticoagulants
compression stockings
intermittent pneumatic compression devices
avoid SAD
eliminate persistent smoking and drinking

Question 9

true or false. ~50% DVTs asymptomatic in early stages

Answer 9

true

Question 10

S&S DVT

Answer 10

gradual onset of dull ache, tightness, & P! in calf
edema, possibly pitting (70%)
increased calf girth
calf pain and tenderness (50%)
– Worsened with walking and calf down
possible warmth and redness

Question 11

referral for DVT

Answer 11

urgent if </= 17% probability of DVT with </= 2 CDR
emergency if 75% probability of DVT with >/= 3 CDR

Question 12

DVT may lead to:

Answer 12

pulmonary embolism

Question 13

cause of pulmonary embolism

Answer 13

DVT that moves and lodges into smaller artery supplying lungs

Question 14

risk factors for PE

Answer 14

same as DVT

Question 15

what is known as “the great masqueraders”

Answer 15

PE

Question 16

S&S of PE

Answer 16

respiratory S&S –> SOB, wheezing, rapid breathing
pleuritic chest P! - sudden, sharp and stabbing chest P! exacerbated by:
- deep inspiration
- coughing
- mechanical pain due to lung fascia attaching to ribs and thoracic vertebra (trunk motion, UE motion, thoracic & rib accessory motion testing)
blood with cough
painful breathing at rest
fainting
tachycardia and palpitations

Question 17

referral for PE per CDR

Answer 17

urgent if < 2/6
emergency if ≥ 2/6

Question 18

what is PAD

Answer 18

ischemia leading to symptoms in the most distal area from the blocked artery most often the calf

Question 19

PAD most often found in the ____

Answer 19

LEs

Question 20

risk factors of PAD

Answer 20

≥ 45 years
family hx of MI or sudden death before 55
recent or current smoker
physical inactivity
metabolic syndrome

Question 21

pathogenesis of PAD

Answer 21

atherosclerosis or plaque build up in aa that also promotes vascular constriction thus further limiting circulation
symptoms begin once 50% of a. is narrowed

Question 22

S&S of PAD

Answer 22

intermittent claudication
- LE P! most often the calf, with a similar amount of activity and elevated positions
- bilateral or unilateral
- relieved with rest and dependent positions
- cramping, weakness, pressure or aching

Question 23

S&S distal to ischemic area of PAD

Answer 23

loss of pulses
TTP
muscle atrophy and weakness
loss of hair
cool and bluish skin
bruit on auscultation
possible necrosis/wound

Question 24

in the presence of severe ischemia, P! may also occur ____

Answer 24

at rest and create sleep interruptions

Question 25

what test should you perform with PAD to assess the post. tibial/brachial systolic BP in all 4 extremities
** invalid with HTN

Answer 25

ankle brachial index cuff test in supine

Question 26

what is an abnormal ABI result

Answer 26

< .9 (the lower the worse dz)
>/= 1.4 (poorly compressed veins due to hardened artery from atherosclerosis)

Question 27

how could you differentiate calf pain due to PAD vs stenosis

Answer 27

bicycle test (lean forward goes away = stenosis)

Question 28

how do you differentiate DVT vs PAD

Answer 28

DVT which is more painful in a dependent position and relieved with elevation

Question 29

referral of PAD

Answer 29

urgent to vascular MD

Question 30

what is osteochondritis dissecans

Answer 30

damage to subchondral bone

Question 31

incidence/prevalence of osteochondritis dissecans

Answer 31

rare
younger boys through early adulthood
males
medial femoral condyle and talus

Question 32

etiology of osteochondritis dissecans

Answer 32

mostly unknown
joint rotational or shearing trauma like a sprain

Question 33

pathogenesis of osteochondritis dissecans

Answer 33

ischemia (AVN) then separation of subchondral bone from convex and weightbearing end bones
overlying articular cartilage can remain visible

Question 34

S&S of osteochondritis dissecans

Answer 34

may be asymptomatic with incidental imaging
if symptomatic, persistent pain not progressing as expected
may progress into severe pain if fragment displaces with joint locking, catching and swelling

Question 35

S&S of osteochondritis dissecans: hypermobility of involved ligament but with persistent ARJC
- ROM:
- resisted:
- stress tests:
- palpation:

Answer 35

• limited and painful, part. w ext
• may be weak and painful, part. at end range ext
• compression likely (+)
• TTP over femoral condyle

Question 36

referral of osteochondritis dissecans

Answer 36

urgent to MD

Question 37

osteochondritis dissecans may take 2-3 years to revascularize and heal due to the following:

Answer 37

higher BMI
deficient passive restraints
muscle imbalances
impaired proprioception

Question 38

PT implications for osteochondritis dissecans

Answer 38

protection to avoid separation of subchondral bone and articular cartilage into the joint (joint mouse)
non-operative management for stable lesion
surgery for resurfacing or fixation needed for unstable lesion

Question 39

what is reactive arthritis aka Reiters syndrome

Answer 39

acute, infection at site remote from the primary infection (spreads unlike septic arthritis)

Question 40

risk factors of reactive arthritis

Answer 40

IV drug users
high sexual activity
infrequent pelvic examinations
weaker immune system

Question 41

incidence/prevalence of reactive arthritis

Answer 41

targets larger joints in the LE and primarily knee and ankle

Question 42

etiology of reactive arthritis

Answer 42

most commonly from respiratory infection
may occur from GI, genitourinary, and colon infections

Question 43

pathogenesis of reactive arthritis

Answer 43

bacteria stimulates antibody and protein factor production that creates inflammation and tissue damage leading to an arthritic joint

Question 44

S&S of reactive arthritis

Answer 44

begin 1-4 weeks after reccent infection
infection S&S
autoimmune S&S
may progress to incapacitating illness

Question 45

PT implications of reactive arthritis
- observation:
- vitals:
- scan/biomechanical exam:

Answer 45

• redness, swelling
• temp
• like for ARJC
  TTP and warmth
  swollen and tender lymph nodes

Question 46

referral for reactive arthritis

Answer 46

urgent to MD