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Musculoskeletal Conditions II > Women's MSK Issues > Flashcards

Women's MSK Issues Flashcards

1
Q

What percent of women with lumbopelvic pain have some form of pelvic floor dysfunction?

A

95.3%

71% pelvic floor muscle tenderness

66% pelvic floor muscle weakness

41% pelvic organ prolapse

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2
Q

Chronic prostatitis/Chronic pelvic pain syndrome is a common condition worldwide, affecting __ to __ % of adult men.

A

2-10% of adult men

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3
Q

T/F All pregnant women need to be followed closely by a health care provider who provides obstetrics care.

A

True

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4
Q

The ___ trimester is when miscarriages could occur, along with morning sickness.

A

1st

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5
Q

The 1st trimester lasts from week __ to week __.

A

0-12 weeks

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6
Q

The 2nd trimester lasts from week __ to week __.

A

13-27 weeks

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7
Q

The 3rd trimester lasts from week __ to week __.

A

28-40 weeks

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8
Q

[Para/Gravida] is the number of births after 20 weeks gestation.

A

Para

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9
Q

[Para/Gravida] is any pregnancy, regardless of duration.

A

Gravida

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10
Q

A set of multiples (i.e. twins or triplets) are considered a single [para/gravida].

A

para

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11
Q

If a women was pregnant for the first time, what would they be designated as in the notes?

A

P0, G1 or G1, P0

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12
Q

If a women gave birth to 4 children and had a history of 2 miscarraiges, what would they be designated as in the notes?

A

P4, G6 or G6, P4

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13
Q

If a women gave birth to a set of twins and another child, and is currently pregnant what would they be designated as in the notes?

A

P2, G4 or G4, P2

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14
Q

What does GTPALM stand for in the notes?

A

G: gravida (# of pregnancies/gravida)

T: term

P: premature births

A: abortions/miscarraiges

L: # of living children

M: multiple births

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15
Q

What is leukorrhea? (hint: it invovles the vagina in pregnancy)

A

the increase in vaginal discharge

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16
Q

What happens with the cervix during pregnancy? (2)

A

it softens and a mucous plug forms

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17
Q

What reproductive organ produces the numerous hormones during pregnancy?

A

the ovaries

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18
Q

What is mastodynia?

A

It is breast tenderness and an early sign of pregnancy

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19
Q

The thin watery secretion that may come from the nipples during pregnancy is called ____.

A

colostrum

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20
Q

What are the changes during pregnancy that can affect posture? (4)

A

center of gravity shifts, weight gain, skeletal changes, and increase in laxity

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21
Q

During pregnancy, the increased lateral weight shift over a wider base of support is referred to as ______ gait.

A

“waddling” gait

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22
Q

What other changes occur with gait during pregnancy besides waddling? (3)

A

(1) Accentuated transverse pelvic rotation
(2) Increased anterior pelvic tilt
(3) Increased demand on hip abductors, hip extensors, and plantar flexors

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23
Q

What could be leading to increased joint laxity during pregnancy? (3)

A

relaxin, cortisol, or estrodiol

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24
Q

During pregnancy, the abdominal musculature can become overstretched and lead to _______ ____.

A

diastasis recti

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25
Q

During pregnancy, the pelvic floor muscles undergo a long prolonged stretch and what two things can be uncovered as a result?

A

(1) muscle weakness
(2) lack of coordination

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26
Q

What 3 senses can be impacted as a result of pregnancy acting on the nervous system?

A

(1) smell
(2) taste
(3) vision (i.e. excessive fluid retention, changes in curvature of cornea, or increase size of blind spot)

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27
Q

What possible nerve impingements can occur during pregnancy? (6)

A

(1) femoral/lateral femoral cutaneous
(2) sciatic nerve (i.e. piriformis)
(3) median
(4) tibial
(5) thoracic outlet syndrome
(6) obturator/pudendal nerves (during labor)

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28
Q

What metabolic changes occur during the anabolic stage (early pregnancy)? (3)

A

(1) Increase in maternal fat storage
(2) Increase in insulin sensitivity
(3) Nutrients stored to meet feto-placental and maternal demands of later gestation and lactation

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29
Q

What metabolic changes occur during the catabolic stage (late pregnancy)? (3)

A

(1) Decrease in insulin sensitivity
(2) Increase in insulin resistance
(3) Increase in maternal glucose and free fatty acid concentrate (required for fetal growth)

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30
Q

On average, women gain __to__% in body weight or __to__ lbs during pregnancy.

A

20-25% in body weight

29-31 lbs

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31
Q

What changes occur in the respiratory system during pregnancy? (hint: ribs, lung volumes, and breathing vitals) (5)

A

(1) Rib mobility decreases (i.e. subcostal angle widens and ribs flare laterally)
(2) Ribcage circumference increases by 10-15cm
(3) Diaphragm is elevated and lung capacity decreases by 4-5%
(4) Increase in tidal volume by 35-50%
(5) No change-slight increase in RR

32
Q

75% of healthy pregnant women may complain of ______ on exertion by ___ weeks.

A

dyspnea with exertion by 31 weeks

33
Q

Maternal oxygen consumption increases by __to__ in pregnancy because of the women’s increased cardiac and respiratory work, added breast and uterine tissue, and placenta, and fetus.

A

10-20% increase in oxygen consumption

34
Q

Why does maternal hyperventilation occur?

A

To protect the fetus from excessive levels of CO2

35
Q

What happens with the size and position of the heart during pregnancy?

A

The heart is displaced upward and somewhat to the left, and its size increases by about 12%

36
Q

Why is the heart position displaced during pregnancy?

A

Because of uterine enlargement and diaphragm and elevation

37
Q

Blood pressure [increased/decreases] during pregnancy, reaching the [highest/lowest] at 28 weeks.

A

decreases, lowest

38
Q

Cardiac output during pregnancy increases by ___% and depends on maternal positioning.

A

40%

39
Q

Cardiac output during pregnancy will decrease in supine after the ___ week.

A

20th week

40
Q

What are the HR changes that occur with pregnancy? (4)

A

(1) Increased HR throughout pregnancy (+12bmp)
(2) Increased HR during low intensity exercise
(3) Normal HR during moderate intensity exercise
(4) Reduced max HR

41
Q

Mechanical pressure by the weight of the uterus leads to a rise in venous pressure in the LE during pregnancy, which leads to what in the ankles and legs?

A

pitting edema (patient should wear support stockings)

42
Q

Why does blood volume increase from 40-50% during pregnancy?(3)

A

(1) Extra blood needed for uterus
(2) Extra metabolic needs dur to the fetus
(3) Need for increased perfusion to other organs, especially the kidneys

43
Q

What is the average blood loss during delivery with (1) vaginal delivery (2) c-section

A

(1) vaginal: 500-600 ml
(2) c-section: 1000 ml

44
Q

What occurs during supine hypotensive syndrome?

A

The pregnant uterus compresses the inferior vena cava and descending aorta when the women is supine, preventing blood flow to the heart and leading to hypotension

45
Q

What hormone levels is nausea/vomiting related to?

A

relative levels of hCG

46
Q

What hormone levels reduce GI motility and also leads to gastric reflux because it relaxes smooth muscle (i.e. intestines or lower esophageal sphincter)?

A

progesterone

47
Q

Incidence of ___ ______ disease is somewhat increased during pregnancy.

A

gall bladder disease

48
Q

Preeclampsia is suspected during pregnancy when there is greater than ___ mg of protein lost in a 24 hr period.

A

500mg of protein

49
Q

Kidney function increases in _____ during pregnancy, resulting in the need to urinate when trying to sleep.

A

supine or lateral position

50
Q

The ureters are dilated in pregnancy, increasing urinary stasis. What can this lead to?

A

Infection

51
Q

Why does urinary frequency occur in (1) early pregnancy (2) late pregnancy?

A

(1) early pregnancy: hormonal changes
(2) late pregnancy: displacement of the uterus

52
Q

Why does pregnancy alter the function of most endocrine glands? (3)

A

(1) the placenta produces hormones
(2) hormones circulate in protein-bound forms
(3) protein binding increases during pregnancy

53
Q

Thyroid stimulating hormones during pregnancy are produced by the ______ and women may show signs that resemble hyperthyroidism as a result.

A

placenta

54
Q

T/F “True” hyperthyroidism occurs in most pregnancies.

A

False, “true” hyperthyroidism only occurs in 0.08% of pregnangies

55
Q

What produces estrogen and progesterone?

A

The ovaries, then the placenta during pregnancy

56
Q

Estrogen regulates the production of what other hormone?

A

progeesterone

57
Q

Estrogen is important for the development of what in the baby? (4)

A

(1) lungs
(2) kidneys
(3) liver
(4) adrenal glands

58
Q

What else is estrogen important for beside fetal development? (4)

A

(1) Development of placenta
(2) Lactation process
(3) Modification of glucose metabolism and the increased need for insulin
(4) Connective tissue changes

59
Q

Progesterone relaxes smooth muscle therefore inhibiting ______ contractibility during early pregnancy.

A

uterine contractibility

60
Q

What other functions does progesterone have during pregnancy? (6)

A

(1) Increases core temperature (0.5 degrees)
(2) Increases sensitivity to CO2
(3) Works with relaxin relaxing muscles, ligaments, and joints
(4) Prepares breasts for lactation
(5) Promotes fat storage
(6) Modifies glucose production/increases need for insulin

61
Q

Relaxin is present throughout pregnancy and has continued increase in levels during nursing, what does it do? (4)

A

(1) relaxes ligaments in body and cuts collagen production while increasing collagen breakdown
(2) inhibits contractions of uterus, playing role in timing of delivery
(3) softening and lengthening of cervix

62
Q

The most common medical complication during pregnancy is ________ ________.

A

gestational diabetes

63
Q

Why does gestational diabetes occur?

A

The hormones of pregnancy block the action of insulin, so this may lead to gestational diabetes

64
Q

What 4 questions might you add to a subjective history with a pregnant patient?

A

(1) Pregnancy history
(2) Prior exercise prior to pregnancy?
(3) How does your OB feel about this pregnancy?
(4) How does your OB feel about you exercising?

65
Q

What conditions are common during pregnancy or post partum? (7)

A

(1) LBP
(2) SI Joint Pain
(3) Pubic Symphysitis
(4) Transient Osteoporosis (usually hip)
(5) Carpal Tunnel
(6) de Quervain’s Tenosynovitis
(7) Leg Cramps

66
Q

T/F You can manipulate a pregnant patient.

A

True…maybe…in the thoracic spine, but for sure not the pelvis or lumbar spine

67
Q

90% of pregnant women had a post partum flare of ______ ______

A

ankylosing spondylitis

68
Q

⅔rd of pregnant women experience remission of ______ ________ and have a flare 6 weeks postpartum.

A

rheumatoid arthritis

69
Q

__% of women during pregnancy experience LBP.

A

77%

70
Q

What is the most common cause of LBP during pregnancy?

A

SI Joint

71
Q

What is the incidence of radiculopathy in pregnant women?

A

The same as general population

72
Q

What are the signs of transient osteoporosis in the hip?

A

groin pain, limping, positive hip provocative maneuvers

73
Q

What is the American College of Obstetricians and Gynecologists (ACOG) guidelines for non-complicated pregnancies and exercise?

A

Strong recommendation to start exercising (150 minutes of moderate intensity 3 days/week)

74
Q

Exercising while pregnant requires an extra ___ calories/day.

A

300 calories/day

75
Q

What are the contraindications for exercise while pregnant? (8)

A

(1) heart disease
(2) restrictive lung disease
(3) incompetent cervix/cerclage
(4) multiple gestation at risk for premature labor
(5) persistent 2nd or 3rd trimester bleeding
(6) placenta previa after 26 weeks of gestation
(7) premature labor during current pregnancy
(8) pregnancy induced hypertension

76
Q

When should exercise be stopped during pregnancy? (9)

A

vaginal bleeding, SOB before exertion, headache, chest pain, muscle weakness, calf pain or swelling, preterm labor, decreased fetal movement, or amniotic fluid leakage

Musculoskeletal Conditions II (20 decks)

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