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ClinMed Exam 1 - Spring > Pathologies Related to the Low Back #2 > Flashcards

Pathologies Related to the Low Back #2 Flashcards

1
Q

What is ankylosing spondylitis?

A

A type of spondyloarthropathy OR spondyloarthritide

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2
Q

What is the etiology of ankylosing spondylitis?

A
  • Genetics: 90% are positive for HLA-B27 antigen on a blood test
  • Environmental
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3
Q

What is the incidence level/ prevalence of ankylosing spondylitis?

A
  • Almost as common as RA
  • Onset < 40 and typically between 15-30 yrs.
  • Biological males 2-3x > females
  • MOST common in lumbosacral region
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4
Q

What is the pathogenesis of of ankylosing spondylitis?

A
  • Chronic inflammation at cartilage, tendon, ligament, and synovium attachments to bone
    (entheses)
  • Erosive bony overgrowth and osteopenia (weakened bone)
  • Leads to fusion of involved joints
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5
Q

What does ankylosing spondylitis look like on an x-ray?

A

Shows up as a bamboo appearance

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6
Q

What are common signs and symptoms of ankylosing spondylitis?

A
  • Autoimmune S&S
  • Multi-jt. inflammation and P!
  • Familial predisposition
  • Extraarticular involvement of eyes, skin, GI tract, and renal and cardiac systems
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7
Q

What condition do some describe as “hurts to see, pee, and bend my knee”

A

Ankylosing Spondylitis

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8
Q

What might you see in terms of multiple joint inflammation and P! when it comes to ankylosing spondylitis?

A
  • > 30 min. of P!/stiffness after prolonged positions
  • Improved P! with easy and regular movement
  • Chronic inflammation and P! of axial skeleton MOST often
  • Asymmetric or unilateral extremity involvement to a lesser degree
  • Typically, of smaller extremity joints but can affect larger ones
  • Localized to entheses or insertions of ligaments, tendons, and fascia- so numerous – itis’
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9
Q

What kind of history might someone with ankylosing spondylitis present with?

A
  • Progressive LBP primarily from greatest influence on sacroiliac (SI) jts. > neck and lumbar regions
  • Onset < 40 yrs.
  • Insidious lasting > 3 mths.
  • No change with rest
  • Night pain from static positioning
  • Buttock and hip P!
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10
Q

What observations will you see with ankylosing spondylitis?

A
  • Hyperkyphosis
  • Loss of lumbar lordosis
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11
Q

What might you see in your scan and biomechanical exam for someone who has ankylosing spondylitis?

A
  • Multiple directions of limited ROM/accessory motion of involved joints… possibly fused
  • Combined motion: multiple consistent block
  • Limited thorax excursion with manubrial and rib springs, possibly compromising cardiopulmonary function
  • Positive Berlin and Inflammatory Back Pain CPRs
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12
Q

What kind of referral is ankylosing spondylitis?

A
  • Urgent referral to rheumatologist
  • A “Do Not Want To Miss” condition in any young adult with low back pain
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13
Q

What does the berlin criteria tell us?

A

Berlin Criteria: ≥2
- (+) likelihood ratio of 2.2-3.8 or 88% probability
- 70% sensitive
1. AM stiffness
2. P! with rest AND relief with exercise
3. Awakening with LBP during 2nd half of night
4. Alternating buttock P!

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14
Q

What does the IBP criteria tell us?

A

IBP Criteria (≥ 4 = 80% sensitive / 72% specific)
1. < 40 yrs. of age
2. Gradual onset
3. Relief with exercise
4. No change with rest
5. Night P! with improvement getting up

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15
Q

What kind of PT Rx is possible for ankylosing spondylitis?

A
  • Be sensitive to trauma in patients with an AS diagnosis
  • Fall prevention
  • Gentle ROM, manual therapy, and MET considering fragility
  • Postural education
  • All the above would also help with bone pathologies like Osteoporosis and Osteomalacia that will be discussed later
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16
Q

What kind of complications might occur with ankylosing spondylitis?

A
  • Osteoporosis
  • Fractures
  • Craniovertebral subluxations
  • Stenosis
  • Fusion in an upright or MORE often forward bent position
  • Cardiopulmonary disorders
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17
Q

What is prostate cancer?

A

Cancer of the prostate which is a reproductive gland below the bladder that aids sperm function

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18
Q

What is the etiology of prostate cancer?

A

Unknown

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19
Q

What are risk factors for prostate cancer?

A
  • African American Men
  • Older than 65
  • Genetics
  • Chemical exposure
  • High fat, red meat diet
  • Obesity
  • Alcohol consumption
20
Q

What is the incidence level/ prevalence of prostate cancer?

A
  • ONLY biological males and typically > 65 yrs. of age
  • 2nd MOST common cancer and death in American men
  • African Americans > European Americans
21
Q

What is the pathogenesis of prostate cancer?

A

Disorganized gland cells infiltrate the prostate

22
Q

What kind of signs and symptoms might you see with prostate cancer?

A
  • Cancer S&S
  • Lumbopelvic P!
  • Primary tumor
  • Bladder dysfunction
  • Sexual dysfunction
  • More common a metastatic tumor
23
Q

What should you inquire about yearly after the age of 55 yrs. with people who have had or might be at risk for prostate cancer?

A

Inquire about Prostate Specific Antigen (PSA) screening

24
Q

What has an overall benefit for bladder dysfunction?

A

Pelvic Floor Muscle Training (PFMT)

25
Q

What kind of referral is prostate cancer?

A

Urgent MD referral

26
Q

What is pancreatitis?

A
  • Severe inflammation of the pancreas
  • May be acute (reversible) or chronic
27
Q

What does the exocrine gland do?

A

Secretes enzymes for digestion, converting food/fluid to fuel

28
Q

What does the endocrine gland do?

A

Releases insulin for sugar regulation

29
Q

What is the etiology of pancreatitis?

A
  • Chronic alcohol consumption and smoking
  • High triglycerides that render insulin and receptors useless = Diabetes
  • Obesity: contributions from high triglycerides
  • Trauma
  • Genetics
  • Infectious agents
30
Q

What is the pathogenesis of pancreatitis?

A
  • Toxicity to pancreas cells
  • Gallbladder bile refluxes into pancreas causing inflammation and possible fibrosis
31
Q

What are signs and symptoms of pancreatitis?

A
  • Sharp right upper quadrant P! that radiates to the thoracolumbar region
  • Worsened by fatty meals or drinking alcohol due to difficult digestion
  • P! relieved with knees closer to chest that decreases stretch on pancreas
  • N&V
  • Possibly jaundiced or yellowed
  • May progress to infection S&S and vital and mental status changes
32
Q

What is the Grey-Turner sign? (for pancreatitis)

A

Swollen flanks

33
Q

What is the Cullen sign? (for pancreatitis)

A

Swollen umbilicus

34
Q

What condition may lead to scarring in thoracolumbar region and be unmodifiable to JMs

A

Pancreatitis

35
Q

What is the referral for pancreatitis?

A

Urgent and possibly emergent MD referral depending on severity

36
Q

What is an abdominal aortic aneurysm?

A

Aneurysms are weakening’s in a vessel wall

37
Q

What is the incidence level/ prevalence of an abdominal aortic aneurysm?

A
  • Aorta is MOST common site
  • Biological males > females
  • Increasing frequency due to aging population
38
Q

What are the risk factors of an abdominal aortic aneurysm?

A
  • Smoking
  • > 50 yrs. of age
  • Biological male > female
  • Vascular diseases i.e., atherosclerosis and collagen disorder- weakens vessel walls
  • Genetics: family hx of AAA
39
Q

What is the etiology of an abdominal aortic aneurysm?

A
  • Trauma
  • Vascular disease
  • Infection
40
Q

What is the pathogenesis of an abdominal aortic aneurysm?

A

Weakening and loss of elastin in vessel walls

41
Q

What is the history of an abdominal aortic aneurysm?

A
  • Often asymptomatic and identified incidentally during assessment of unrelated condition
  • MOST often LBP but possibly abdominal and flank P!, especially with activity
  • Searing, ripping, or tearing back or abdominal P! that stops all activity indicates impending or actual rupture
42
Q

What might you observe with an abdominal aortic aneurysm?

A

Abdominal heartbeat

43
Q

What might you feel when you are palpating for an abdominal aortic aneurysm?

A

A non-tender palpable mass (≥ 3 cm) that pulses, typically just left of midline from umbilicus

44
Q

What is more diagnostic than palpation for an abdominal aortic aneurysm?

A

A bruit with auscultation over abdominal aorta

45
Q

True or False: With an abdominal aortic aneurysm you will have absent or diminished pulses elsewhere.

A

True

46
Q

What kind of referral is an abdominal aortic aneurysm?

A
  • A “Do Not Want To Miss” condition
  • Emergency referral: MOST die before getting to the hospital

ClinMed Exam 1 - Spring (4 decks)

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