Summary on common pathologies/coniditions Flashcards

1
Q

Osteoporosis Summary

A
  • Increased bone resorption causes a decrease in bone density, brittle, weak bones
  • More osteoclast activity than osteoblast
    -Fractures in L and T spine. Distal arm, femoral neck
  • Do extension and core strengthening to improve postural stability
  • AVOID flexion w/ resistance or deep flexion, heavy resistance, and ballistic movements. avoid rotation Too much stress in the spine due to flexion moment
  • DO weight-bearing and resistance training as tolerated, aquatic therapy for conditioning but need WB/strengthening specifically (lunges, rows, leg press, etc.)
  • Medications include calcium, Vit D. Raloxifene, Fosamax
  • DEXA less than -2.5 is osteoporosis, -1 to -2.5 is osteopenia
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2
Q

Peripheral Arterial Disease

A

Narrowing of the lumen in blood vessels due to arteriosclerosis
- Intermittent claudication (cramping/pain, pallor w/ elevation and rubor in dependent position b/c blood flow is stuck due to occlusion), relieved with rest
- Other sx are Hair loss in the region, pain at rest, slow healing changes in skin color decreased temp, weakened pulse
- Higher risk for other circulatory issues
- Anticoagulants, anti platelets, thrombolytica to prevent clots

Exercise Program
4-6 weeks includes intermittent walking close point of max pain, then rest until fully relieved then repeat. Working up to 30 min straight. Include dynamics resistance and aerobics

=Leads to collateral circulation

For night sx, lift bed 4-6 inches for perfusion in legs

A type of PVD

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3
Q

Multiple Sclerosis

A

CNS disease with demyelination of neurons specifically in CNS. Impacts motor and sensory.

Sensitive to heat
Cognitive changes
Motor and sensory issues
Balance issues
Loss of coordination so closed chain exercise is better

Key sx - optic neurits (vision issues b/c optic nerve involved), UMN signs, weakness, coordination

Exercise 50-70% moderate intensity
Need breaks and days off
Alternate body parts within session

Type
- clinically isolated is first time and/or only time
- Relapsing remitting includes attacks followed by some level of recovery and no decline in between
- Secondary progressive is when it goes from relapsing remitting with recovery periods to constant decline aka disease progression-
- Primary progressive is when there is a constant decline throughout

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4
Q

Guillain-Barre Syndrome

A

-Often in response to infection
- RAPID onset with demyelination of peripheral nerves
- Distal to proximal weakness
- Decreased DTR, sensory disturbances
GBS typically involves rapid onset, bilateral ascending weakness or paralysis, as well as changes in sensation in a stocking-glove pattern (typically).

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5
Q

Myasthenia Gravis Summary

A
  • Damage to neuromuscular junctions due to increase in anti-acetylcholine receptors
  • Women ins 20s, 30s
  • Cranial nerves impacted first= eye weakness, ptosis, chewing and facial weakness
  • Proximal muscle like neck
  • Severe fatiguing throughout day due to issues with nerve firing
  • No UMN

ptosis that may fluctuate, and often, muscles involving speech, chewing, or swallowing are affected, as well.

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6
Q

Osteoarthritis

A

Always consider age in diff dx
Heberden’s nodes in fingers (more distal than bouch)
Stiffness less than 30 min morning

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7
Q

Cauda Equina syndrome

A

Anything L2 and below including sacral levels
Bowel and bladder changes
More radicular pain than lower back (makes sense because more distal nerve roots)
Saddle anesthesia
Absent reflexes
GRADUAL AND UNILATERAL
Severe pain Spinchther dysfunction is later

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8
Q

Conus Medullaris syndrome

A

L1-L2 level
Greater lower back pain than radicular (makes sense b/c more proximal in lumbar region)
Hyperreflexia (UMN)
SUDEEN AND BILATERAL
Early change in sphincter

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9
Q

Juvenile Rheumatoid Arthritis

A

Similar to RA
16 years or younger, girls more than boys
The most common type is pauciarticular which includes 4 joints or less and is seen is girls 8 or younger, Asymmetrical
vs
more severe polyarticular JRA is symmetrical and more than 4 joints
Expect contractures and periarticular damage and symptoms
Expect less ROM in functional activities like gait

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10
Q

Diabetes

A

Understand that if uncontrolled, then concerns are hyperglycemia b/c no insulin so no uptake into muscles

But if controlled and taking insulin, then concern is hypoglycemia, especially with exercise b/c increased uptake into other tissues. Important to have carbs before or during exercise.

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11
Q

Horners syndrome vs bells palsy

A

Horners is Loss of sympathetic nerve function to one side of face causeds loss of sweat (anhidrosis), ptsosis, miosis (pupil size smaller)

Bells palsy is facial nerve palsy on one side

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12
Q

Spinal stenosis

A

Prefers flexion, not extension

Supine positioning and encouragement of core training in order to increase muscular support for the lower back would be recommended for a patient with spinal stenosis.

In patients with spinal stenosis, exercises that encourage low back extension should be avoided; therefore long-distance ambulation on a flat surface would not be the most appropriate exercise for the PT to recommend.

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13
Q

Duchenne Muscular Dystrophy

A

Fat and CT begin to replace muscle due to the mutation of the dystrophin

Stretch Hip flexors and plantar flexors

2-5 yo

Gowers maneuver

Fatty deposit (pseudohypertrophy in calf)

Rapid progression cant walk by 10

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14
Q

Myelopathy

A

LMN at the level of lesion
UMN below the lesion
BL involvement (both motor and sensory)

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15
Q

Poly neuropathy

A

Motor, sensory, and autonomic changes BL in distal regioins

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16
Q

CRPS 1 vs 2

A
  1. (no known nerve injury)
  2. (known nerve injury)

Stage 1 - Hyperalgesia, allodynia, hyperpathia , edema, sweating, thin shiny skin
Stage 2 - pain gets worse Everything from stage 1 plus nail changes
Stage 3 - Cont to worsen, hardening, cool, dry, cyanotic skin, osteoporosis, anklylosis

17
Q

RA

A

related to cervical myelopathy
Gold therapy with methotrexate (DMARD)

MCP POP bilaterally
Progressive muscle weakness
Stiffness greater than 30 min

Swan neck and boutinneires

Low impact activity due to lig laxity

AA instability due to damage to transverse ligament of c spine
DONT stretch swollen joints
Modailites, gentle massage, immobilize
PROM AAROM within limits of pain

18
Q

Cerebellar disease

A

Does not do UMN signs like babinski
Just ataxia tone, coordination etc.

19
Q

Pagets Disease

A

Metabolic bone disorder

Drug therapy required

PT is for joint and bone protection strategies

Impacts spine, pelvis, femur, skull, tibia

20
Q

Osteogenesis Imperfecta

A

Type 1: Mildest. A little fragile fractures (normal life)

Type 2: worst. Dies in vitro or early childhood. Many deformities

Type 3: Severe Notable signs are triangular face and bleu sclera, many diff deformities

Type 4: Mild but still mild signs and symptoms, fractures, brittle teeth, barrel rib cage, etc. (normal life expectancy)

In general they are hypermobile, joint laxity, and osteoporosis etc.

Interventions is all about safety, stability etc.

21
Q

Oshgood Slatters interventions

A
22
Q

Patellofemoral syndrome

A

Stair climbing, jumping, prolonged sitting makes it worse
They have increased Q angle
Normal Q angle 13 for men 18 for women

Mob for medial glide patella

NO deep squats

Patellar taping for tracking
Diff than patellar tendonitis (overuse injury)

23
Q

Lyme Diseases

A

Bullseye rash
Large joints effected like knee

24
Q

Myofascial pain syndrome vs fibromyalgia

A

MPS = Localized trigger points with referred pain (to unrelated regions)

Fibromyalgia = fatigue generalized tendon points, IBS, sleep issues

25
Q

Psoriatic arthritis

A

SIlvery scaly knees., elbows
Skin rash red spots
Mouth ulcers
Symmetrical distal arthritis like fingers and toes

26
Q

Reactive arthritis

A

= Reiters syndrome
Autoimmune due to bacterial and venereal diseases including Chrons

Dactylyitis = sausage swelling in fingers

DO NOT STRETCH SWOLLEN JOINTS

Cant see (conjunctivitis)
Cant pee
Cant bend the knee

27
Q

Somatoform Disorders

A

Conversion - Real mental condition leads to physical symptoms

Malingering - Made up symptoms (fabricated)

       Waddell signs help detect the faker
        Tenderness test
        Simulation test
         Distraction test
         Not reflective of neuroanatomy 

Body dysmorphic disorder

28
Q

Huntington disease

A

Causes unwanted movements (chorea)
Progressive hereditary
Excessive motor excitation
BG atrophy

Issues with voluntary movements
Choreic movements
“Cerebellar like issues”

Treated with anticonvulsants, and agents to block dopamine
Auditory curing for gait, sx based

29
Q

Charcot-Marie-Tooth disease (CMT)

A

is a group of genetic conditions that affect the nerves in the body, including the nerves in the hands and feet.

30
Q

Uncontrolled diabetes vs diabetic ketoacidosis

A

Given this patient’s relevant past medical history of DM and current status, it is more likely that this patient is experiencing uncontrolled DM. The patient reports an increase in thirst and urination, along with sensory changes in the hands and feet. That, along with the PT’s observation of poor wound healing, makes this the most likely diagnosis in this case.

Diabetic ketoacidosis is a life-threatening state and would require immediate medical intervention. Patients experiencing ketoacidosis often present with a fruity odor to their breath and may be confused - they may also appear flushed and have an elevated temperature. This patient has symptoms that are more consistent with uncontrolled DM rather than this emergency state.

31
Q

Duchenne Muscular Dystrophy

A

Signs
- Gowers sign
- Weak hip ext
- Tight hip flex, gastroc
- pesudohypertrophy of calves
- Lorddosis

Fat and CT replace muscle

Dx 2-5 yo

Cannot ambulate by age 8-10
Death by 20 usually if not they are not functional, require power wheelchair

Understand disease will progress rapidly, cant walk by 10
Interventions focused on maintaining what they do have and staying as independent as possible

32
Q

Spondy

A

Lumbar flexion will not reverse lordosis b/c actual slippage

extension makes worse b/c more pressure on slippage area.

stepp off derformity

NO EXTENSION
Abdominal strengthing and stabilization are key

33
Q

Ankylosing Spondylitis = Marie- Strumpell Disease

A

Men 20-40 most liekly
Spine and large peripheral joints affected with inflammation and fibrosis
Starts with low back and extends t thoracic, cervical, impacting posture, flattening back, hip contractures ], etc. can impact chest breathing
Other systematic. issues later on cause is systemic.

POSTURAL EXCERCISES WITH EXTENSION TO WORK ON POSTURE, like osteoporosis

Low impact exercises with extension and rotation are GOOD unlike spondy and unlike osteoporosis

AvOID high impact flexion activities like osteoporosis

Swimming highly recommended
No surgery

= Similar interventions to osteoporosis except add extension

actually may lead to osteoporosis

UNLIKE spondy

Varying prognosis, may stay to one area, but not a death sentence