systemic pathology Flashcards
1
Q
FMS signs and symptoms? 7
A
Pain Fatigue Lowered respiratory function Reduced joint ROM Impaired muscle endurance Impaired muscle strength Lowered CV fitness levels
2
Q
FMS tender points on back of body? 5
A
occiput midpoint of upper border of trap supraspinatus above medial scap border gluteal upper quad of buttocks greater troch
3
Q
FMS tender points on front of body? 4
A
lower cervical C5-C7
2nd rib/costochondral junctions
lat epic
knee medial fat pad prox to jt line
4
Q
Etiology of FMS? 2
A
unclear..maybe peripheral nerve or CNS
absent lab findings
functional limitations important
5
Q
CFS cause?
A
unclear
6
Q
CFS accompanying disorders? 4
A
neurasthenia
chronic Epstein-Barr virus
myalgic encephalomyelitis
7
Q
CFS – Signs and Symptoms? 6
A
Sore throat, tender cervical or axillary lymph nodes, muscular pain, multijoint noninflammatory arthralgia, impairment in memory or concentration, debilitating fatigue for 6 months�
8
Q
percent of pt with CFS that also have FMS?
A
70%
9
Q
percent of pt with CFS that are bedridden and unable to work?
A
25%
10
Q
percent of pt with CFS that can only work part time?
A
33%
11
Q
Multidisciplinary approach to treatment of CFS and what intervention is most effective?
A
Exercise
pharmacologic
psychological=most effective
12
Q
Benefits of exercise in CFS cases? 6
A
Muscle performance Aerobic capacity Range of motion Posture Response to emotional stress Decreased Pain
13
Q
Early phase exercises/tx for FMS? 6
A
stress and pain management relaxation autogenic deep breathing deep breathing visualization stretching
14
Q
Midphase exercises/tx for FMS? 6
A
MS balance fluoromethane spray and stretch self mobs NM tech like PNF/hold and relax closed chain eccentric early aerobic (aquatics, supine bike)
15
Q
Late-phase exercises/tx for FMS? 5
A
maintenance stretch MS balance strength and closed chain eccentric aerobic NWB and WB
16
Q
Exercise for impaired muscle performance in FMS? 3
A
- Initially – Low resistance, low repetition when addressing strength deficits.
- Exercise can be isometric or dynamic (slow movements).
- Calibrate progressions according to patient’s response.
17
Q
Exercise for impaired aerobic performance in FMS? 4
A
- Introduce aerobic exercise as soon as possible.
- Initial intervention should be limited (2–5 minutes) with attention to patient response.
- Gradual increase according to tolerance levels.
- By late phase, patients may tolerate elevation of HR to 50–60%.
18
Q
Exercise for impaired ROM in FMS? 2
A
- Hypermobility (stabilization training during agonist strengthening exercises)
- Graded flexibility exercises. Remember, stretching should never be painful.
19
Q
Exercise for impaired posture in FMS?
A
- Consider ALL postures
- Static posture is starting point and end point for return to function
- Eccentric control is frequently lost
- Tai Chi Chuan, Feldenkrais, and low-level exercise strategies may help restore muscle balance and function
20
Q
Tx of pain in FMS? 4
A
Assess FMS and biomechanical aspects.
Eliminate biomechanical origin as part of whole approach.
Consider patient’s adherence and the relationship to symptoms.
Consider adjunctive and cognitive behavioral approaches.
21
Q
Precautions and Contraindications for FMS? 4
A
Adherence to an exercise program may be challenging due to perceived overexertion.
Clarity of instruction should be reinforced via checklists and written guidance.
Pacing is crucial for those who are chronically fatigued.
Exercise applications and dosage should be closely monitored to reduce concerns related to perceived expectations of pain
22
Q
Of CFS and FMS, which may have a viral component?
A
CFS
23
Q
Do exercises appear to be effective for both FMS and CFS?
A
yes for FMS, possibly for CFS
24
Q
FMS & CFS have widespread effects and __________.
A
limit functioning
25
Exercise prescription should be done ______ and tracked __________.
done carefully
| tracked continuously
26
What do exercise for CFS and FMS address? 5
```
stress
posture
mobility
muscle performance
CV endurance.
```
27
Aerobic exercise should be _____ impact and progress _______.
low impact
| progress slowly
28
For FMS and CFS, use of physical agents may be taught as ___________ agents to make best use of clinical time.
self-treatment
29
Inflammation is characterized by? 5
```
Rubor (redness)
Swelling
Calor (heat)
Pain
Diminished function
```
30
Inflammatory disorders can be further characterized as? 4
Infectious
Rheumatic
Metabolic
Regional inflammation related to overuse
31
Hematogenous Osteomyelitis is what?
Localized/generalized inflammation of bone due to pyogenic infection spread by blood stream
�
32
Hematogenous Osteomyelitis is most common in who?
boys
33
Hematogenous Osteomyelitis usually effects what part of which bones in children?
metaphysis of the tibia and femur
34
Osteomyeltis can be ____ or ______.
acute or chronic
35
In Osteomyeltis, nutrient vessels are quite
| convoluted in bone, which allows _________.
bacteria to be trapped in the metaphysis
36
What is a secondary concern in Osteomyeltis?
joint infection may occur in shoulder and hip as a result of synovial membrane inserting distally to epiphysis, allowing bacteria to spread directly from metaphysis to the joint space
37
Signs and symptoms of Osteomyeltis? 4
Severe/constant pain near the end of the affected long bone with exquisite tenderness to palpation
May be febrile, report malaise, weight loss
Life threatening condition
Treated with aggressive antibiotic regimen, surgical debridement
38
In Osteomyeltis, how soon do radiographic changes appear?
10-14 days, initial x-rays usually normal
39
What develop in Osteomyeltis?
Draining sinuses develop if untreated due to increased pressure from accumulation of pus
40
In Osteomyeltis, what does lab work reveal?
elevated leukocyte counts due to infection
41
What is Septic Arthritis?
The synovial fluid becomes contaminated with bacteria
42
Septic Arthritis is often secondary to what?
Osteomyeltis
43
Who is most often affected by Septic Arthritis?
often affects children or adults over 60
44
In SA the body’s immune response can have what effect?
destroy both bacteria and joint surfaces
45
How can Septic Arthritis be introduced? 3
- Direct penetration (open fx; surgery)
- Extension into the joint from adjacent infection (osteomyelitis, infected wound)
- Bloodstream (skin, respiratory, UTI)
46
What jts does Septic Arthritis often affect? 6
the hip or knee, but can also affect hands, feet, shoulders, wrists
47
Symptoms of SA? 4
moderate to severe joint pain, calor, tenderness, decreased ROM and muscle spasm
48
How is diagnosis confirmed in SA? 2
X-rays and joint aspiration/culture confirm diagnosis
49
PT treatment options for SA during the infection? 1
Joint protection/splinting
50
PT treatment options for SA after the infection? 3
Progressive ROM
Strengthening
Functional activities
51
5 Inflammatory Rheumatic Diseases?
```
Rheumatoid Arthritis (RA)
Juvenile Rheumatoid Arthritis (JRA)
Ankylosing Spondylitis
Reiter’s Syndrome
Psoriatic Arthritis
```
52
How does RA differ from OA?
RA attacks joints in a balanced way (Bilateral involvement)
53
RA is a ___________ disease and is more common in _________.
"prime of life"
| women
54
RA is usually seen in what jts first?
small joints of the hands, wrists, elbows, ankles, MTP’s
55
What does lab work show in RA?
usually shows elevated RA factor, but not necessarily all cases. ALSO, elevated RA factor can be seen in people without the disease as well as with other diseases.
56
Do x-rays show early changes in RA?
no
57
RA signs and symptoms? 5
```
a.m. stiffness lasting > 30 mins. (OA stiffness usually gets better within 30 mins.)
Weight loss
Fatigue
Muscle atrophy
Subcutaneous nodules in chronic phase
```
58
How is RA treated? 6
```
Disease-modifying antirheumatic drugs (DMARDs) that can slow or sometimes prevent joint destruction are recommended early in the course of the disease.
Joint replacement
Splinting/joint fusion
Joint protection
Strengthening
Modalities
�
```
59
What is Ankylosing Spondylitis?
Autoimmune disease affecting the spine
60
Who is more often affected by Ankylosing Spondylitis?
men, more severe
61
Is there a genetic predisposition in Ankylosing Spondylitis�?
yes
62
Ankylosing Spondylitis involves what structures?3
ligamentous insertions, fibrocartilage, and discs
63
How does AS present in paravertebral soft tissue?
lesion manifests as a formation of new bone within the outer layers of the annulus fibrosis
64
What invades the margins of the disks in AS?
hyperemic granulation tissue arising from the subchondral bone
65
Signs and symptoms of AS? 5
Usually presents as morning back stiffness
Can see diminished chest expansion due to costal joint involvement
Weight loss
Fever
Increased kyphosis
66
Treatment of AS? 4
Postural training
Extensor muscle strengthening
ROM
Pharmaceuticals including steroidal and non-steroidal anti-inflammatory meds
67
What is Reiter's syndrome?
Infection passed through sexual contact or enteric bacterial infection due to improperly handled foods (Not contagious per-se, but affects people who are predisposed to develop the disease)
68
What is the Reiter's syndrome triad?
conjunctivitis, arthritis, nonspecific urethritis
69
Reiter's syndrome mnemonic?
"the patient can't see, can't pee and can't climb a tree"
70
Reiter's syndrome commonly results in inflammation of what?
tendinous insertions (Achilles' tendonitis, plantar fascitis)
71
Many cases of Reiter's syndrome resolve after ____ to _____ months.
4 to 5
72
Tx for Reiter's syndrome? 5
```
antibiotics
exercise
relaxation
joint protection
modalities
```
73
What is Psoriatic Arthritis?
Chronic, erosive form of polyarthritis associated with psoriasis
74
Psoriatic Arthritis occurs in what % of people with psoriasis?
5-7%
75
When might Psoriatic Arthritis be suspected?
if psoriasis and arthritic complaints present together
76
Is Psoriatic Arthritis usually asymmetric or symmetric?
asymmetric when compared to RA
77
How is Psoriatic Arthritis treated?
like RA
78
One specific sign of Psoriatic Arthritis?
pitting of the nails
79
What is one kind of Metabolic Arthritis?
Gout
80
What is gout?
recurrent acute or chronic arthritis of peripheral joints. VERY PAINFUL.
81
What does gout result from? specific
that result from deposition in and about the joints and tendons of monosodium urate (MSU) crystals from supersaturated hyperuricemic body fluids
82
How can MSU crystals be detected in the joint in gout?
seen or felt as subcutaneal nodules
83
Who is most likely to get gout?
men over 40
84
Attacks of gout can be precipitated by conditions that produce what?
metabolic acidosis
85
6 things that can cause metabolic acidosis
```
trauma
diet/alcohol
fatigue
stress
infection
medication
```
86
How is gout treated? 6
```
colchisine,
NSAIDS,
joint aspiration,
steroid injection,
joint mobility after episode,
special footwear
```
87
How can hemophilia cause arthritis?
Constant bleeding into the joint causes an inflammatory response from the synovium �
88
In hemophilia, when can joint bleeding occur?
after trauma or just spontaneously
89
Joints most often affected by hemophilia? 5
```
knee,
elbow,
ankle,
hip,
shoulder
```
90
Hemophilia can result in what chronic jt changes? 3
decreased ROM
atrophy
flexion contractures
91
Hemophilia can result in prolonged mild or severe ________.
joint swelling
92
Hemophilia changes visible in an x-ray. 3
- synovial proliferation and hyperemia
- widening intercondylar notch of femur
- enlarged epiphyses
93
PT tx of hemophilia? 3
protecting joints
protective strengthening of surrounding ms
avoiding stress to the affected joints
94
2 specific soft tissue inflammations and the cause?
Bursitis
Tendonitis
Result of trauma and overuse
95
What is Osteoarthritis?
jt degeneration caused by wear and tear, with possibility of genetic predisposition
96
Evidence of OA on X-ray (especially early on) does not necessarily mean that there will be ________.
frank functional deficits
97
Osteoarthritis affects what types of its?
axial and peripheral
98
What is primary OA?
no specific trauma; just wear and tear
99
What is secondary OA?
Major trauma that precedes the progression of OA
100
Three common physiological effects of OA? 2 bone, 1 cartilage
hypertrophy and spurring of bone
| cartilage erosion
101
OA cycle? 6 unique steps
```
ligament weakness
excessive jt movement
jt bones collide
jt crepitus
bone overgrowth (called arthritis)
more lig strain
more lig weakness
```
102
Types of benign bone tumors (neoplasms)? 5
```
osteochondromas
benign chondroma
chondroblastoma
osteoid osteoma
giant-cell tumors
```
103
Osteochondromas
most common benign bone tumor- occur most between ages 10-20
104
Benign chondroma
located centrally within a bone (marrow cavity). Ages 10-30
105
Chondroblastoma
rare benign neoplasm that arises from the epiphysis. Ages 10-20
106
Osteoid osteoma
benign lesion most often found in long bones. Pain relieved by small doses of aspirin is classic
107
Giant-cell tumors
: benign lesions that occur in the epiphysis of long bones that may erode the parent bone and produce soft extensions. Tend to recur, and linked to later sarcoma development
108
Primary Malignant Tumors of Bone? 6
```
Osteosarcoma
Fibrosarcomas
Malignant Fibrous
Histiocytoma
Chondrosarcoma
Mesenchymal chondrosarcoma
Ewing’s Sarcoma
```
109
Osteosarcoma
highly malignant tumor with tendency to metastasize to the lungs. About ½ the lesions are found in the knee, but can occur anywhere.
110
Dx and tx of Osteosarcoma?
biopsy (not x-ray)
| chemo and surgery means 50% pt live +5 yrs
111
11 Clinical signs and symptoms of osteosarcoma. List 15, just for laughs
```
age 5-30
dull aching pain
night pain (growing pain)
history of minor trauma, or sprain/ms strain
fever/night sweats
local tenderness
swelling or mass
ms atrophy
limp
pathologic fx
lymphadenopathy
```
112
Chondrosarcoma
malignant tumor of cartilage
113
Dx and Tx of chondrosarcoma
Dx can be made only by biopsy.
Tx is total surgical resection
NO radiation and chemotherapy=ineffective.
114
Mesenchymal chondrosarcoma
rare but distinct type of chondrosarcoma; cure rate is low.
| �
115
Ewing’s Sarcoma
peak incidence between 10 and 20. Pain and swelling are the most common symptoms. Requires biosy to differentiate. ~ 50% cure rate with combined therapies
116
Malignant metastatic lesions of bone most often arise from what primary carcinomas?
```
prostate
breast
kidney
thyroid
lung
```
117
Anyone known to have or have had CA should be evaluated how?
with skeletal X-rays to r/o metastatic bone disease
118
Anyone known to have or have had CA should be evaluated how?
with skeletal X-rays to r/o metastatic bone disease
