Test 3: Pathologies Related to the Knee

Question 1

what is deep vein thrombosis

Answer 1

partial or complete occlusion of a vein by a clot

Question 2

etiology of DVT

Answer 2

50% is unknown

other half involve conditions that have at least 2 of the following: venous stasis, hypercoagulability, or damage to the venous wall

Question 3

conditions that may be more likely to produce DVT

Answer 3

prior DVT
hx of cancer/CHF/lupus
major infection/sx/trauma
chemotherapy
immobility
pregnancy
use of oral contraceptives/hormone therapy
genetic clotting disorder (i.e. Willebrand)
>60 years old

Question 4

incidence and prevalence of DVT

Answer 4

3rd most common cardiovascular disease

most common in deep LE veins

most preventable cause of hospital related deaths

most common cause of readmissions and death after THA/TKA

Question 5

common veins that develop DVT

Answer 5

popliteal

femoral

tibial

peroneal

Question 6

pathogenesis of DVT

Answer 6

greater exposure of platelets and clitting factors to a damaged venous wall

fibrin, leukocytes, and erythrocytes adhere and form thrombosis

Question 7

what could be done to prevent/treat DVT

Answer 7

early and regular exercise
anticoagulants
compression socks
intermittent pneumatic compression devices
avoid SAD
eliminate persistent smoking/drinking

Question 8

caution with early and regular exercise for DVT

Answer 8

as a prevention it is great

be cautious/wait for anticoagulant therapy to take effect to avoid a PE from motion with treatment if a clot is already present; DO NOT WANT TO MOVE CLOT

Question 9

what might be included in pt history if they have DVT

Answer 9

50% of individuals are asymptomatic in early stages

typically a gradual onset of a dull ache/tightness/calf pain

Question 10

CDR for DVT include what factors

Answer 10

edema; possibly pitting in 70% of pts

increase calf girth

calf pain/tenderness in 50% of pts; worse with walking; relief lessens as condition worsens

possible redness/warmth

Question 11

PT implications for DVT

Answer 11

referral to MD per CDR

urgent referral if <17% with less than 2 CDRs

emergency if 75% and 3 or more CDRs

do not want to miss

may lead to pulmonary embolism

Question 12

etiology/pathogenesis of Pulmonary Embolism

Answer 12

DVT that moves and lodges into the smaller artery supplying the lungs

Question 13

S&S of pulmonary embolism

Answer 13

often non specific… “the great masqueraders”

SOB/wheezing/rapid breathing may be only symptom

pleuritic chest pain; sudden/sharp chest pain that can be exacerbated by:
-deep inhale
-cough
-mechanical pain may occur due to lung fascia attachment to ribs/thoracic vertebrae (i.e. trunk, UE, or rib motion)

Question 14

other/possibly less common S&S of pulmonary embolism

Answer 14

blood with cough
painful breathing at rest
fainting
tachycardia and palpitations

Question 15

referral for PE

Answer 15

urgent of <2/6

emergency if greater than or equal to 2/6

Question 16

what is peripheral artery disease

Answer 16

ischemia leading to symptoms in the most distal area from the blocked artery; most often on calf

Question 17

where is peripheral artery disease most common

Answer 17

most often in LEs

Question 18

risk factors for peripheral artery disease

Answer 18

over 45
family hx of MI or sudden death before 55
recent or current smoker
physical inactivity
metabolic syndrome

Question 19

pathogenesis of peripheral artery disease

Answer 19

artherosclerosis or plaque build up in aa that also promotes vascular constriction thus further limiting circulation

symptoms begin once 50% of a is narrow

Question 20

S&S of intermittent claudication with peripheral artery disease

Answer 20

LE pain; most often in calf with similar amount of activity and elevated positions

can be uni or bilateral depending on where blockage is

relief with rest and dependent position

often described as cramping but may be weakness/pressure/aching

Question 21

S&S of peripheral artery disease distal to the ischemic area

Answer 21

loss of pulses
TTP
muscle atrophy/weakness
loss of hair
cool/bluish skin
bruit on auscultation
possible necrosis/wound

Question 22

how might pain act in the presence of severe ischemia

Answer 22

pain at rest

can cause sleep interruptions

Question 23

steps for ankle brachial test

Answer 23

take BP at posterior tibial a and brachial a (on both sides)

just looking at the ratio of the ankle systolic/brachial systolic

Question 24

concerning levels for ankle brachial test

Answer 24

less than 0.9 is bad

the lower the worse the dieases

over 1.4 may indicate poorly compressed vv due to hardened aa from artherosclerosis

Question 25

how to differentiate calf pain due to PAD vs stenosis

Answer 25

bicycle test

start in an upright position and then after a few minutes have them lean forward

if pain goes away with forward bend then it indicates stenosis

if it doesnt go away it can indicate the pain is from the muscles not getting enough bloodflow

Question 26

referral for peripheral artery disease

Answer 26

urgent to vascular MD

Question 27

what is osteochondritis dissecans

Answer 27

damage to subchondral bone

Question 28

incidence/prevalence of osteochondritis dissecans

Answer 28

rare

most common in younger boys through early adulthood

males > females

most common in medial femoral condyle and talus

Question 29

etiology of osteochondritis dissecans

Answer 29

mostly unknown

joint rotational or shearing trauma like a sprain

Question 30

pathogenesis of osteochondritis dissecans

Answer 30

ischemia (AVN) then separation of subchondral bone from convex and WBing end bones

overlying articular cartilage can remain viable

Question 31

clinical manifestations/S&S of osteochondritis dissecans

Answer 31

may be asymptomatic with incidental imaging

is symptomatic = persistent pain; not progressing as expected

may progress into severe pain if fragment displaces with joint locking/catching/swelling

S&S of hypermobility/instability of involved ligament but with persistent ARJC-like symptoms

Question 32

what specific S&S may occur that mimic hypermobility/instability/ARJC with osteochondritis dissecans

Answer 32

ROM limited and painful especially with ext

resisted MMT = weak/painful especially at end range ext

compression likely +

TTP over femoral condyle

Question 33

referral for osteochondritis dissecans

Answer 33

urgent

Question 34

what is reactive arthritis (aka)

Answer 34

aka Reiter’s syndrome

acute infection that is at a site remote from the primary infection (septic arthritis is infection AT SITE of primary infection)

Question 35

risk factors for reactive arthritis

Answer 35

IV drug use
high sexual activity
infrequent pelvic exams
weaker immune system

Question 36

incidence/prevalence of reactive arthritis

Answer 36

targets larger joints in the LE and primarily the knee and ankle

Question 37

etiology of reactive arthritis

Answer 37

most commonly from a respiratory infection

could also be from GI, genitourinary, and colon infections

Question 38

pathogenesis of reactive arthritis

Answer 38

bacteria stimulates antibody and protein factor production that creates inflammation and tissue damage leading to an arthritic joint

Question 39

clinical manifestations/S&S of reactive arthritis

Answer 39

begins 1-4 weeks after a recent infection

infection S&S

autoimmune S&S

may progress to incapacitating illness

Question 40

osteochondritis dissecans can take up to 2-3 years to revascularize and heal due to these stresses/stability

Answer 40

higher BMI
deficient passive restraints
M imbalances
impaired proprioception

Question 41

Why is it important to protect the joint after having osteochondritis dissecans

Answer 41

want to avoid separation of bone and articular cartilage into the joint

aka joint mouse

common at the knee

loss of joint surface congruency

Question 42

how to treat a stable osteochondritis dissecans lesion vs non stable

Answer 42

stable = non operative; smae Rx as instability/ARJC

sx required for resurfacing or fixation that is needed for unstable lesions

Question 43

observation / vitals of those with reactive arthritis

Answer 43

redness
swelling

fever

Question 44

what might you find with scan anf BE exam for reactive arthritis

Answer 44

like ARJC

TTP and warm

swollen and tender lymph nodes

Question 45

referral for reactive arthritis

Answer 45

urgent