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clin med II - exam I > Pathologies Related to the Low Back II > Flashcards

Pathologies Related to the Low Back II Flashcards

1
Q

What is ankylosing spondylitis?

A

a type of spondyloarthropathy or spondyloarthritide
- literally means fused spine inflammatory disease

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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 prevalence of ankylosing spondylitis?

A
  • almost as common as RA
  • onset < 40 and typically between 15-30 years
  • biological males 2-3x more than females
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4
Q

Where is ankylosing spondylitis most common?

A

LUMBOSACRAL REGION

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5
Q

What is the pathogenesis of ankylosing spondylitis?

A
  • chronic inflammation at cartilage, tendon, lig, and synovium attachments to bone
  • erosive bony overgrowth and osteopenia
  • leads to fusion of involved joints
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6
Q

What is osteopenia?

A

Weakened bone

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7
Q

What are common S&S of spondyloarthropathies or spondyloarthritides?

A
  • autoimmune S&S
  • multi-joint inflammation and pain
  • familial predisposition
  • extraarticular involvement of eyes, skin, GI tract, and renal and cardiac systems
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8
Q

What can we find with multi-jt inflammation with spondyloarthropathies or spondyloarthritides?

A
  • > 30 mins of pain stiffness after prolonged positions
  • improved pain with easy and regular movement
  • chronic inflammation and pain 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, tensions, and fascia – numerous “itis”
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9
Q

What are PT implications of ankylosing spondylitis found in the history?

A
  • progressive LBP primarily from greatest influence on SIJ > neck and lumbar regions
  • onset < 40 yrs
  • insidious lasting > 3 months
  • no change with rest
  • night pain from static positioning
  • butt and hip pain
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10
Q

What will we see during observation with ankylosing spondylitis?

A

Hyperkyphosis
- loss of lumbar lordosis

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11
Q

What becomes symptomatic first with ankylosing spondylitis?

A
  • SIJ, then neck, then back
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12
Q

What are clinical manifestations of ankylosing spondylitis found in our scan & biomechanical exam?

A
  • multiple directions of limited ROM/accessory motion of involved joints, possibly fused
  • combined motion = consistent block
  • limited thorax extension with manurial and rib springs, possibly compromising cardiopulmonary function
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13
Q

What kind of referral is ankylosing spondylitis?

A

Urgent referral to rheumatologist

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14
Q

What population is ankylosing spondylitis a DO NOT MISS condition in?

A

young adults, men especially, with LBP

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15
Q

What is the Berlin criteria for ankylosing spondylitis?

A

88% probability, 70% sensitive
1. AM stiffness
2. Pain with rest and relief with exercise
3. awakening with LBP during 2nd half of night
4. alternating buttock pain

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16
Q

What is the LBP criteria with ankylosing spondylitis?

A
  1. < 40 years of age
  2. gradual onset
  3. relief with exercise
  4. no change with rest
  5. night pain with improvement getting up
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17
Q

What are PT implications as far as treatment for ankylosing spondylitis?

A
  • be sensitive to trauma in patients with an AS diagnosis
  • fall prevention
  • gentle ROM, MT, and MET considering fragility
  • postural education
  • all of the above would also help with bone pathologies like osteoporosis and osteomalacia that will be later on
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18
Q

What are complications that may 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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19
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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20
Q

What is the etiology of prostate cancer?

A

unknown

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21
Q

What are risk factors for prostate cancer?

A
  • age and ethnicity
  • genetics
  • chemical exposure
  • high fat, red meat diet
  • obesity
  • alcohol consumption
22
Q

What is the incidence/prevalence of prostate cancer?

A
  • only biological males and typically > 65 years of age
  • 2nd MOST COMMON cancer and death in American men
  • African Americans > European Americans
23
Q

What is the pathogenesis of prostate cancer?

A
  • disorganized gland cells infiltrate the prostate
24
Q

What are clinical manifestations of prostate cancer?

A
  • cancer S&S
  • lumbopelvic pain
  • primary tumor
    > bladder dysfunction
    > sexual dysfunction
25
Q

What should we ALWAYS check?

A

Bowel and bladder status

26
Q

What should we inquire about yearly after the age of 55?

A

Prostate specific antigen screening (PSA) yearly

27
Q

What can benefit bladder dysfunction?

A

pelvic floor muscle training (PFMT)

28
Q

What is the referral of prostate cancer?

A

Urgent MD referral

29
Q

What is the function of the pancreas?

A
  • exocrine gland: secretes enzymes for digestion, converting food/fluid to fuel
  • endocrine gland - releases insulin for sugar regulation
30
Q

What will we find with pancreatitis regarding pancreas function?

A

Severe inflammation

31
Q

Is pancreatitis acute or chronic?

A

May be either

32
Q

What is the etiology of pancreatitis?

A
  • chronic alcohol consumption and smoking
  • high triglycerides that render insulin and receptor useless = diabetes
  • obesity = contributions from high triglycerides
  • trauma
  • genetics
  • infectious agents
33
Q

What is the pathogenesis of pancreatitis?

A
  • toxicity to pancreas cells
  • gallbladder bile refluxes into pancreas causing inflammation and possible fibrosis
34
Q

What are clinical manifestations for pancreatitis?

A
  • sharp right upper quadrant pain that radiates to the thoracolumbar region
  • worsened by fatty means or drinking alcohol due to difficult digestion
  • pain relieved with knees close to chest that decreases stretch on pancreas
  • N&V
  • jaundiced or yellow
  • Grey- Turner sign (swollen flanks)
  • Cullen sign (swollen umbilicus)
35
Q

What is Grey-Turner sign? (pancreatitis)

A

swollen flanks

36
Q

What is Cullen sign? (pancreatitis)

A

Swollen umbilicus

37
Q

What can pancreatitis lead to?

A
  • scarring in thoracolumbar region and be unmodifiable to JMs
38
Q

What kind of referral is pancreatitis?

A

Urgent and possibly emergent MD referral depending on severity

39
Q

What is an AAA?

A

Abdominal Aortic Aneurysm

40
Q

What is an aneurysm?

A

Weakenings in a vessel’s walls

41
Q

What is the incidence/prevalence of aneurysms?

A
  • Aorta is MOST common site
  • males > females
  • increasing frequency due to aging population
42
Q

What are risk factors for AAA?

A
  • smoking
  • over 50 years of age
  • males> females
  • vascular diseases (such as atherosclerosis and collagen disorders, weakens vessel walls)
  • genetics (family hx of AAA)
43
Q

What is the etiology of AAA?

A
  • trauma
  • vascular disease
  • infection
44
Q

What is the pathogenesis of AAA?

A

weakening and loss of elastin in vessel walls

45
Q

What are the clinical manifestations of AAA we will find in hx?

A
  • often asymptomatic and identified incidentally during assessment of unrelated condition
  • MOST often LBP but possible abdominal and flank pain, esp with activity
  • Searing, ripping, or tearing back or abdominal pain that stops all activity indicated impending or actual rupture
46
Q

What indicates an impending or actual rupture?

A

Searing, ripping, or tearing back or abdominal pain that stops all activity

47
Q

What will we observe with AAA?

A
  • abdominal heartbeat
48
Q

What will we find with palpation with AAA?

A

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

49
Q

What will we find with ausculation with an AAA?

A

bruit with auscultation over AA that is more diagnostic than palpation
- absent or diminished pulses elsewhere

50
Q

What kind of referral is an AAA?

A

Emergency referral - MOST die before getting to the hospital

clin med II - exam I (4 decks)

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