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ClinMed Exam 1 - Spring > Pathologies Related to the Low Back #3 > Flashcards

Pathologies Related to the Low Back #3 Flashcards

1
Q

What is nephrolithiasis?

A

Kidney stones or renal calculi

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2
Q

What makes up the urinary system?

A

Structure: kidneys, ureters, bladder, and urethra

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3
Q

What is the urinary system function?

A
  • Filter fluid from renal blood flow
  • Remove waste
  • Retain essential substances for electrolytes and ph
  • Stimulates RBC production
  • Blood pressure regulation
  • Converts Vitamin D (absorbs Ca2+) to its active form
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4
Q

What is the etiology and risk factors for nephrolithiasis?

A
  • Disorders that lead to hyperexcretion of Ca2+ and uric acid i.e. Hyperthyroidism
  • NOT primarily drinking water
  • Obesity
  • High animal protein intake
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5
Q

What is the incidence/ prevalence of nephrolithiasis?

A

3rd MOST common urinary tract disorder behind
infections and prostate conditions

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6
Q

What is the pathogenesis of nephrolithiasis?

A

Hard mass of salts composed of Ca2+ > uric acid and other minerals deposited in urinary system

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7
Q

What signs and symptoms might you see with nephrolithiasis?

A
  • Referred P! into T10-L1 dermatomes
  • May begin with intermittent unilateral LBP
  • Progress to acute/severe back and flank (between ribs and iliac crests) and possibly abdominal P!
  • Radiating P! to the groin and perianal regions
  • Bladder dysfunction
  • Eventually unrelenting P!
  • N&V due to P! severity
  • Infection (kidney or urinary tract) could occur so infection S&S may be present
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8
Q

What might you find with percussion and palpation with nephrolithiasis?

A
  • Murphy percussion test over kidney determines referral
  • One firm and closed fisted percussion over 12th costovertebral angle
  • WNL = painless
  • P! also may be present with bladder palpation/percussion
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9
Q

What kind of referral is nephrolithiasis?

A

Urgent but possibly emergent referral depending on pain severity

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10
Q

Is the skeleton metabolically active?

A

Yes

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11
Q

The skeleton undergoes continuous remodeling throughout life with an _____ turnover of bone.

A

Annual

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12
Q

Remodeling of the skeleton is necessary to?

A
  • Maintain the structural integrity of the skeleton
  • Serve metabolic demands as a storehouse of Ca2+ and phosphorus
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13
Q

Bone mass peaks between what ages?

A

25-35 yrs

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14
Q

What is osteoporosis?

A

Persistent, progressive metabolic disease characterized by:
- Low bone mass
- Impaired bone quality
- Decreased bone strength
- Enhanced risk of fractures

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15
Q

What are the two types of osteoporosis?

A
  • Primary: MOST common and associated with aging
  • Secondary: consequence of disease or medication
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16
Q

What is the incidence level/ prevalence of osteoporosis?

A
  • Not often a presenting diagnosis
  • 70% undiagnosed; found during investigation of
    other conditions
  • Increasing number in younger individuals
  • Expected to increase with aging population
  • Highest in post-menopausal biological women with
    estrogen deficit and Scandinavian ancestry
  • 33% of biological women and 20% of biological men
    over 50 yrs. will suffer an osteoporotic fx
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17
Q

What is the most common metabolic bone disease?

A

Osteoporosis

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18
Q

What is a precursor to Osteoporosis?

A

Osteopenia or low bone mass

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19
Q

What are risk factors of osteoporosis?

A
  • Lower Estrogen
  • Genetics
  • Social habits: > 2 beers, > 1 glass of wine, > 1 liquor shot or > 3 cups (8 oz. in a cup) of caffeine per day
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20
Q

Lower estrogen levels causes what?

A
  • Limits release of Ca2+ into blood and absorption
  • Associated with menopause and abnormal menses
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21
Q

Lower testosterone levels cause what?

A

Lower testosterone also limits release of Ca2+ into blood

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22
Q

Genetics play what role in osteoperosis?

A
  • Plays a role with parathyroid hormone for Ca2+ balance and smaller bone stature
  • Family history
23
Q

What are risk factors for osteoporosis?

A
  • Physical inactivity
  • Depression alters hormone levels
  • Meds, particularly ≥ 3 months of corticosteroid use
  • Tobacco- smoking AND smokeless
  • Low Vit. D and Ca2+ levels associated with eating disorders, low protein, SAD, or conditions that alter absorption of nutrients
24
Q

Ensure patients with risk factors have a Dexa (DXA) scan along with what other individuals?

A
  • Biological women at 65 yrs.
  • Biological men at 70 yrs.
  • Osteoporosis Risk Assessment
  • Age: greater than or equal to 75 +15; 65-74 + 9; 55-64 + 5
  • Weight in lbs.: < 132 +9; 132-154 +3
  • Not taking estrogen +2
  • < 9 LR- 0-.61 to NOT need a bone scan
25
Q

What is the primary pathogenesis of osteoporosis?

A

Primarily a metabolic disorder as osteoclastic activity > osteoblastic activity

26
Q

What is the secondary pathogenesis of osteoporosis?

A

Secondarily an endocrine disorder due to other conditions that limit Ca2+ regulating and sex (estrogen/testosterone) hormones for bone health

27
Q

What are the additional pathogenesis of osteoporosis?

A
  • Loss of inner cancellous bone
  • Wedging, compression, and fx of vertebral body MOST often in lower thoracic and upper lumbar regions
  • Femurs, ribs, and radius are also common areas of fx- non-traumatic > traumatic
28
Q

What are signs and symptoms of osteoporosis?

A

Often asymptomatic until a fx occurs, however objective changes may be observed

29
Q

What might you observe with osteoporosis?

A
  • Forward head posture
  • Loss of height
  • Increased thoracic and lumbar kyphosis: fulcrums or rounded and slouched posture
30
Q

When do fracture typically occur with osteoporosis?

A

Fx often occurs with a seemingly benign flexion activity i.e., bending or sneezing

31
Q

What might you see in combination with fracture signs and symptoms in someone with osteoporosis?

A

Fx S&S plus…
- Severe back P! potentially between mid-thoracic and upper lumbar region especially with flexion, compression, and Valsalva stresses
- P! may refer to flanks and abdominal region;

32
Q

What will ROM look like in someone with osteoporosis?

A

P! and limitation, primarily with flexion but possibly all directions

33
Q

What will resistive tests look like in someone with osteoporosis?

A

P! and weakness, primarily with flx but possibly with all directions

34
Q

What will stress tests look like in someone with osteoporosis?

A
  • P! with compression; likely relief with distx
  • P! with PA pressures
35
Q

What will neuro tests look like in someone with osteoporosis?

A

MOST often negative but possible in more severe cases

36
Q

What will you find in your biomechanical exam for someone with osteoporosis?

A
  • Percussion: LR+ = 8.8; LR- = .147
  • Supine Sign: inability to lie supine due to P! (LR+ 11.6; LR- .2)
37
Q

What is Romans CPR for osteoporosis?

A
  • Greater than 52 yrs. of age
  • No, LE P!
  • BMI < 22
  • No regular exercise
  • Biological female
  • Criteria for compression fx
38
Q

What is the criteria for compression for someone with osteoporosis?

A

Criteria for compression fx
- Less than or equal to 1 LR- = .16
- Greater than or equal to 4 LR+ 9.6

39
Q

What kind of referral is osteoporosis?

A

If suspected fx…
- Most likely urgent referral
- Emergency referral if neurological symptoms or inability to walk

40
Q

True/ False: Most osteoporotic fx are stable and able to tolerate Rx due to ligamentous structure so proceed based on symptoms.

A

True

41
Q

To minimize vertebral body compression, what should be positional and directional preferences with education, treatments, and activities?

A
42
Q

How else can you minimize vertebral body compression?

A
  • Bracing
  • Assistive devices: cane or reacher
43
Q

What is your MET focus for someone with osteoporosis?

A
  • Bone integrity- maintenance or improving density
  • Balance
  • Walking and resistance training
44
Q

What should your manual therapy be focused on with someone with osteoporosis?

A
  • Cautious with JM, particularly higher grades may be contraindicated, if advanced level of disease or > 3 months of corticosteroid use
  • May utilize JM to normalize motion and stresses throughout spine
45
Q

How long might it take someone with osteoporosis to heal/ decrease their pain?

A

Majority will heal after 8 to 12 weeks of conservative treatment with subsequent decline in pain

46
Q

What kind of MD Rx can be provided and how does it compaire to PT Rx for osteoporosis?

A
  • Percutaneous vertebroplasty
  • Good treatment for some patients with acute/subacute P!
  • Addition of exercises vs. none provided better subjective outcomes starting at 6 months and lasting out to two years following sx
47
Q

What is osteomalacia?

A
  • Bone softening without the loss of bone mass or brittleness as with osteoporosis
  • Also, a metabolic disease
48
Q

What are the etiologic factors of osteomalacia?

A
  • Insufficient intestinal Ca2+ absorption due to lack of Ca2+ or more likely low Vit. D.
  • Increased phosphate loss
  • Kidney conditions
  • Long term antacid use
  • Hyperparathyroidism disorder that alters Ca2+ balance
49
Q

What are the risk factors for osteomalacia?

A
  • Lack of dietary or sunlight Vit. D
  • Malabsorption conditions including age that affect digestive and metabolic functions
  • Medications that alter Vit. D, Ca2+ , or phosphate i.e., antacids and anticonvulsants
50
Q

What is the pathogenesis of osteomalacia?

A
  • Lack of bone minerals, Ca2+ and phosphates, leading to soft bones with possible fx but more likely bending
  • NO affect on osteocytes
  • Primarily affects vertebra and femurs
51
Q

LBP, pelvic and LE pain is aggravated by what is osteomalacia?

A

Weight bearing

52
Q

Ca2+ is not only needed for bone strength and hormones but neuromuscular function so people with osteomalacia experience what due to a lack of this?

A
  • Myalgia/Arthralgia
  • Proximal muscle weakness and polyneuropathy
  • Altered gait/increased falls
53
Q

What kind of deformities might you see in someone with osteomalacia?

A
  • Increased thoracic kyphosis
  • Genu varum- bow legged
54
Q

True/ False: Osteomalacia has a similar referral and Rx as osteoporosis?

A

True

ClinMed Exam 1 - Spring (4 decks)

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