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Clin Training Phase I - Beck > Week 3: Study Qs > Flashcards

Week 3: Study Qs Flashcards

1
Q

What are the common sacroiliitis diseases?

A
  • RA
  • Infections
  • Seronegative arthropathies: AS, Reiter’s, Psoriatic arthritis, enteropathic arthropathies (Chronic, UC), undifferentiated spondyloarthropathies
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2
Q

What are the four general types of signs and symptoms associated with seronegative arthropathies?

A

MSK Spine: local SI inflammation, progressive, insidious, migratory P possible, P less influenced by body mechanics

MSK extra-spinal: concomitant joint pains (hip) enthesitis (commonly the heel, rotator cuff, greater torch, patella, tibial tubercle, base of 5th metatarsal, costochondral junctions), osteitis, synovitis

Non-MSK general: fever, malaise, fatigue, etc.

Non-MSK specific: rash, GI or GU disorders

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3
Q

What the signs and symptoms that suggest the presence of AS?

A
  • Age <40 yo
  • Sx 3+ months
  • Morning stiffness <30 mins
  • Improvement with exercise, not rest
  • Wake 2nd half of night because of P
  • Insidious onset
  • Myospasm in glut max or piriformis
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4
Q

Areas of inflammation in AS?

A 
Eyes 40%
Neck 75%
Rib/spine junction 70%
Lumbosacral 50%
Sacroiliac 100%
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5
Q

What two special physical examination procedures should be done?

A
  • Schober’s test normal is at least 5cm

- Respiratory excursion normal is >5cm

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6
Q
  1. What eye-related symptoms might a patient have? How would the eye problem be managed?
A

20-40% patients get Uveitis: redness, photophobia, pain, blurry

TX: sunglasses, corticosteroids, antibiotics

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7
Q

What ancillary tests should be ordered?

A
  • ESR or CRP
  • CBC shows anemia of chronic disease (normocytic or normochromic)
  • Likely (+) for HLA-B27
  • Negative tests: Rh factor and anti-cup (for rheumatic arthritis), negative ANA

Radiographic evidence of SI

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8
Q

Mgmt plan for AS?

A

Manipulate in non-acute phase/blocking, mobilizing in acute phase.
STM g max, piriformis
Stay active between flare ups
Core spinal exercises w/ emphasis on extension, stretch muscles, postural training
• meds: NSAIDS, TNF blockers

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9
Q

What 5 screening Qs to ask if you suspect AS?

A
  • morning stiffness?
  • Improve with exercise?
  • Onset pain before 40 yo??
  • Slow onset?
  • Pain persisting >3 months?
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10
Q

What are the components of the 4-part diagnosis?

A

Pathoanatomical
Neurological/radiating
Biomechanical
Complicating factors

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11
Q

What are the characteristics of the pathoanatomical diagnosis?

A

1˚ Dx and 1st for billing purposes (except Medicare) and gets ICD code.

Addresses: location of structure and type of (anatomical damage, inflammation, tearing of tissues) injury to that structure. Or a type of headache. Or a type of nerve entrapment.

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12
Q

What are some pathoanatomical Dx examples for low back pain?

A 
Spinal canal stenosis
Lumbar sprain/strain
Lumbar facet syndrome  
Spondylolisthesis (if considered primary cause)
Sacroiliac syndrome
Sacroiliitis 
Ankylosing spondylitis
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13
Q

Pathoanatomical Dx Examples for neck pain?

A 
Cervical sprain/strain
Cervical facet syndrome 
Cervical stenosis (when primary)
Guillain Barre syndrome
Cervicocranial syndrome
Cervical herniated disc 
Hyperextension-hyperflexion injury (acceleration-deceleration injury)
Tension headache 
Vascular headache 
Cervicogenic headache 
Cervicobrachial syndrome 
Brachial traction injury 
Thoracic Outlet Syndrome 
T4 syndrome 
Maigne syndrome
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14
Q

Does the patient have to have pathoanatomical Dx?

A

Yes because its the 1˚ Dx in most cases

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15
Q

What are some examples of neurological components?

A

S1 radiculopathy into right foot
Deep referred pain (sclerotogenous) into posterior thigh
Left foot paresthesia
Myofascial pain referral over right eye

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16
Q

What are examples of biomechanical component?

A

Joint dysfunctions: segmental dysfunction, joint dysfunction, subluxation syndrome

Muscle dysfunctions: myospasm, MFTP, myofibrosis

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17
Q

Can there be more than 1 biomech component?

A

Yes

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18
Q

What is the first step in differential diagnosis for a low back pain patient?

A

Injury or disease

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19
Q

How common is serious disease as a cause of low back pain?

A

<3% of LBP is d/t serious disease

2:1 Belly:Back (1% is spinal, 2% is visceral)

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20
Q

What recommended ancillary tests do we usually start with for a patient with red flags?
If cancer or infection?
If arthritic condition?
If urinary problem?

A

Radiograph, then MRI, CT, bone scan
ESR or CRP
CBC

Cancer/infection: blood chem panel

Arthritis: anti-CCP, RF, ANA, HLA-B27

Urinary: UA

21
Q

What are the 3 main indicators for ordering a radiograph?

A
  • Red flags for disease
  • Trauma
  • Evidence of spinal neuro damage (radiculopathy, CES, neurogenic claudication)
22
Q

Should age > 50 years old generally prompt a radiograph in patients with LBP?

A

No

23
Q

What are two additional situations when you should consider ordering a plain film radiograph?

A

Suspicion of osteoporotic related compression Fx

Tx failure >1month

24
Q

Are most metastatic spinal cancers osteolytic or osteoblastic? What is an example of both?

A

MC = osteolytic

Osteolytic=breast
Osteoblastic=prostate

Note: cancer spares the disc unlike infection

25
Q

What 2 changes do you expect radiographically with a spinal infection?

A

End plates eaten away and eventually more of the bone will disappear.

Loss of disc (cancer spares the disc)

26
Q

What blood tests are often increased in a spinal infection?

A

76-100% ESR

61% Leukocytosis

27
Q

ESR stands for

A

Erythrocytes sedimentation rate

28
Q

About how sensitive is a radiograph on the first patient visit to detect spinal cancer?

A

68% ability to detect cancer

68% of patients with metastatic/primary bone tumor will have an abnormal x-ray at their first visit.

29
Q

What broad types of conditions (or categories of disease) should you consider when you see an elevated ESR or CRP?

A

Infections, cancers, inflammatory disease

30
Q

Are ESR or CRP generally more sensitive or specific to particular diseases? And what does sensitive/specific mean?

A

They are sensitive (rule out), not very specific (rule in/point to specific condition).

So they are good for screening which means there are a lot of false positives.

31
Q

Explain the 20-50 rule for the ESR (which should REALLY be called the 18-50 rule).

A

<18 mm/hr is normal
18-50 mm/hr is elevated
>50 is probably a significant disease requiring more testing and advanced imaging

32
Q

What 3 disease processes are suspected when >100 mm/hr ESR?

A

Multiple myeloma
Temporal arteritis
Polymyalgia rheumatica

33
Q

Which is more likely to be elevated in most bone cancers, the ESR or the total white count?

A

SED rate are more sensitive to catching cancer compared to white count

34
Q

About how often does cancer cause anemia?

A

50% of the time

35
Q

What types of anemia does cancer cause?

A

90% is normochromic normocytic

10% is microcytic

36
Q

Which type of anemia is MC and what is LC?

A

MC: Normocytic normochromic anemia = 90% chronic disease anemia

LC: Microcytic is not common but chronic disease is the 3rd most common cause of microcytic anemias

37
Q

What would be a blood test finding that would help you differentiate iron deficiency anemia from a microcytic anemia caused by a disease?

A

Iron panel to check Serum Iron and Serum Ferritin

38
Q

If serum iron is decreased AND serum ferritin is decreased, what do you think?

A

Iron def. anemia probably not related to the LBP

39
Q

If Serum iron decreased but normal/elevated serum ferritin?

A

Think of a disease state and do NOT supplement with iron

40
Q

What CBC changes in the white cells might occur in a patient with cancer causing low back pain?

A

Decreased white cells

41
Q

Increased WBC >11,500 is likely what disease?

A

Infection, cancer, inflammatory

42
Q

Increased immature whites is probably what disease?

A

Leukemia

43
Q

Decreased white cells is probably what disease?

A

MM or other cancers

44
Q

What three tests on a blood chemistry panel could give you key information about bone cancers?

A

A. Calcium
B. Alkaline phosphatase (ALP)
C. Protein (globulins)

45
Q

What are the two most common causes of hypercalcemia?

A

A. Metastatic cancer
B. Hyperparathyroidism

Note: never ignore even small increases in serum calcium >10.2 mg/dL. Usually not caused by osteoporosis, and 40-50% pts with metastatic cancer to bone will have elevated calcium.

46
Q

What types of bone related conditions can raise ALP? (5)

A

Blastic lesions: Paget’s disease, healing Fx, growing bones, pregnancy, liver disease

47
Q

What bone condition can raise ALP the most?

A

Paget’s disease

48
Q

When do you order protein electrophoresis? And what are you looking for?

A

When globulins are elevated on serum protein test. Order protein electrophoresis to look for monoclonal spine suggesting multiple myeloma.

Clin Training Phase I - Beck (14 decks)

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