Clinical patterns Flashcards
(145 cards)
1
Q
Paget’s disease epidemiological features
A
European descent, over 55 yo.
2
Q
Paget’s disease aetiology
A
unknown
3
Q
Paget’s disease proposed pathophysiology/pain mechanism
A
excessive osteoclastic bone resorption / increased osteoblastic bone formation - dull or aching pain or no pain
4
Q
Paget’s disease differential diagnoses
A
osteomalacia
5
Q
Paget’s disease symptoms
A
pain + aching of bones / pain worse after lying or sitting
hearing loss
paraethesia
6
Q
Paget’s disease mechanism of injury
A
can have OA in surrounding joints
7
Q
Paget’s disease contributing factors
A
suspected environmental + genetic factors
8
Q
Paget’s disease physical exam findings
A
misshapen bones, affected bones warmer
9
Q
Paget’s disease tests for condition
A
X ray or bone scan
10
Q
Paget’s disease diagnostic interventions
A
alkaline phosphatase (enzyme for bone growth) present
11
Q
Paget’s disease precautions/contraindications
A
high impact PA
12
Q
Paget’s disease prognosis
A
excellent if diagnosed + treated early before hearing loss etc. occurs
13
Q
Paget’s disease physiotherapy management options
A
can help maintain muscle strength, flexibility + joint ROM
14
Q
Paget’s disease other management
A
PA
healthy diet
heat + cold packs
15
Q
Paget’s disease medical management options
A
bisphosphonates - slow progression by controlling bone building process
pain killers
surgery
16
Q
Osteoporosis epidemiological features
A
post menopausal women
older men
17
Q
Osteoporosis aetiology
A
low BMD / micro-architectural deterioration of bone tissue
18
Q
Osteoporosis pathophysiology + pain mechanisms
A
low bone mineral density
no pain unless spinal compression fracture
19
Q
Osteoporosis differential diagnoses
A
osteomalacia
infection
osteonecrosis
20
Q
Osteoporosis symtpoms
A
silent disease
21
Q
Osteoporosis contributing factors
A
smoking/alcohol abuse
decreased PA
decreased calcium, vitamin D, protein intake
some drugs
22
Q
Osteoporosis screening questions
A
early menopause?
history of smoking?
23
Q
Osteoporosis tests for condition
A
scanning axial skeleton w/ dual energy x-ray absorptiometry (DXA)
24
Q
Osteoporosis diagnostic investigatiosn
A
T score of 2.5 or less on DXA
25
Osteoporosis precautions/contraindications
some medications
26
Osteoporosis prognosis
15+ years after diagnosis if take medication + make lifestyle changes
27
Osteoporosis physio management options
measures to prevent falls, improving vision, aids for daily living, promoting exercise
28
Osteoporosis other management
limit alcohol/stop smoking
take vit. d + calcium
increase weight bearing + maintain optimal body weight
29
Osteoporosis other medical management
boniva, reclast
30
Rheumatoid arthritis epidemiological features
female - onset 40s + 50s
male onset 80s
31
Rheumatoid arthritis aetiology
genetic contribution
exposure to certain antigen
32
Rheumatoid arthritis pathophysiology + pain mechansim
- synovitis + synovial hyperplasia
- various cytokines, effector cells + signalling pathways
- proliferation of synovial tissue, infiltration of inflammatory factors
33
Rheumatoid arthritis prognosis
significant disability + early mortality if left untreated
34
Rheumatoid arthritis main problem
inflammation of joints / polyarticular pain + swelling
35
Rheumatoid arthritis area of symptoms
PIP joints (fingers), MCP joints, wrists, knees, ankles, MTP joints
36
Rheumatoid arthritis characteristics of symptoms
ache + stiffness
37
Rheumatoid arthritis behaviour of symptoms
- stiffness worse after inactivity or vigorous exercise
- morning stiffness over 30 mins
38
Rheumatoid arthritis typical activity restriction
cessation of work
39
Rheumatoid arthritis typical history/mechanism of injury
insidious without incident
multiple joints affected
40
Rheumatoid arthritis contributing factors
genetic
41
Rheumatoid arthritis screening questions
personal/family history of autoimmune diseases
42
Rheumatoid arthritis physical examination features
- swelling/redness around joint
- atrophy
- active/passive movements limited
- reduced strength in hands
- muscle length X reducing ROM
43
Rheumatoid arthritis tests for condition
x rays, arthocentesis
44
Rheumatoid arthritis diagnostic investigations
IgM antibodies present in blood tests
45
Rheumatoid arthritis precautions + contraindications
quit smoking
avoid certain food eg. red meat
46
Rheumatoid arthritis physio management options
suggest exercise program
47
Rheumatoid arthritis other management options
assistive devices, home mods
48
Rheumatoid arthritis medical management
surgery, medications eg. analgesics, NSAIDs, corticosteroids, DMARDs
49
Osteoarthritis epidemiological features
female
1 in 3 over 65
50
Osteoarthritis aetiology
obesity, inactivity, past joint injury, muscle weakness
51
Osteoarthritis pathophysiology + pain mechanisms
- degradation of articular cartilage
- thickening of subchondral bone
- inflammation of synovium
pain = tenderness when pressed
52
Osteoarthritis prognosis
joint damage X be undone - increased mortality if untreated
53
Osteoarthritis differential diagnoses
fibromyalgia, rheumatoid arthritis, psoriatic arthritis
54
Osteoarthritis main problem
joint pain
55
Osteoarthritis characteristics of symptoms
stiffness, aching, tenderness
56
Osteoarthritis behaviour of symptoms
better in warmer weather
57
Osteoarthritis contributing factors
past injury, sedentary, overweight, history of trauma
58
Osteoarthritis physical examination findings
functional movement issues
limited active/passive movement
muscle strength + length decrease in muscles around joint
59
Osteoarthritis tests
X rays + MRIs
60
Osteoarthritis diagnostic investigation findings
osteophytes, loss of joint space, bone oedema, bone cysts, capsular thickening
61
Osteoarthritis physio management options
suggest exercise program
62
Osteoarthritis other management options
maintain healthy weight + diet etc.
63
Osteoarthritis medical management options
corticosteroid use
64
Heart failure epidemiological features
old age
65
Heart failure aetiology
heart attack
coronary heart disease
chronic conditions - hypertension, arrhythmias, cardiomyopathy, myocarditis
66
Heart failure pathophysiology + pain mechanisms
when contracting/relaxing action of heart is inadequate b/c heart muscle is weak/stiff
- chest pain/stomach pain
67
Heart failure differential diagnoses
COPD, hypertension
68
Heart failure prognosis
only 50% alive 5 years later
69
Heart failure main problem
bloated stomach, chest pain, coughing, shortness of breath
70
Heart failure behaviour of symptoms
worse when lying down
71
Heart failure contributing factors
unhealthy lifestyle
obesity
drug + alcohol abuse
low PA
72
Heart failure tests
ECG
chest x ray
plasma b-type natriuretic peptide
transthoracic echocardiogram
73
Heart failure diagnostic intervention findings
high levels of BNP
74
Heart failure precautions/contraindications
NSAIDs
75
Heart failure physio management
education re knowing how to recognise worsening symptoms / when action is required
76
Heart failure other management
- treating disorder causing heart failure
- making lifestyle changes
77
Heart failure medical management
drugs or surgery
78
Coronary heart disease epidemiological features
- male / post menopausal women
- maori or south asian descent
- old age
79
Coronary heart disease aetiology
unhealthy diet
inactive
overweight / diabetic
high BP + cholesterol
smoker
80
Coronary heart disease pathophysiology
coronary arteries become less patent b/c of build up of plaque in lining
- insufficient blood to heart muscle -> pain = angina
81
Coronary heart disease prognosis
long life if detected + managed early
82
Coronary heart disease differential diagnoses
- msk system -> spine, ribs, muscles
- heartburn
- lung issues
83
Coronary heart disease main problem
tightness
pressure
burning
breathlessness
sweating
84
Coronary heart disease area of symptoms
chest
chin/jaw
upper back
shoulders
85
Coronary heart disease characteristics of symptoms
stable angina = assoc w/ exertion / worse after meal
unstable angina = unexpected, occurs at rest, X ease w/ rest or medication
86
Coronary heart disease contributing factors
family history
lifestyle factors
87
Coronary heart disease special tests
Coronary angiogram = catheter inserted into heart, dye injected -> shows narrowing
ECG
chest x ray
88
Coronary heart disease precautions + contraindications
avoid certain drugs eg. NSAIDs
89
Coronary heart disease physio management
pre + post surgery
90
Coronary heart disease other management options
lifestyle changes
pharmacological management
surgery
91
Diabetes epidemiological features
type 1 = before 18 yrs old
type 2 = developed after 40 b/c of obesity, poor diet + lack of exercise
92
Diabetes aetiology
build up of glucose in bloodstream
93
Diabetes pathophysiology
type 1 = little/no insulin production by pancreas b/c beta cells destroyed by immune system
type 2 = reduction in body's ability to use insulin
94
Diabetes prognosis
incurable - type 2 diabetics may not need medication if change lifestyle
95
Diabetes differential diagnoses
- drug induced signs + symptoms eg. corticosteroids
- infection
- endocrinopathies eg. hyperthyroidism
96
Diabetes main problem
fatigue
polydipsia
polyuria
polyphagia
weight loss (type 1)
97
Diabetes contributing factors
type 1 = genetics, viral infections, vaccines, toxins, early cessation of breast feeding
type 2 = age, ethnicity, family history, weight, PA levels, diet, smoking
98
Diabetes diagnostic investigations
- random blood test -> glucose above 11mmol/L
- fasted blood test -> 7mmol/L
- haemoglobin -> 6.5% or above
99
Diabetes precautions + contraindications
excessive exercise
certain foods
100
Diabetes physio management
exercise prescription
101
Diabetes other management
diet + lifestyle
102
Diabetes medical management
insulin replacement
103
Falls + fractures aetiology
fall from height that shouldn't cause fracture
osteoporosis
104
Falls + fractures main problem
NOF + Colle's fractures
105
Falls + fractures physio management
exercise prescription
106
Falls + fractures other management
home safety interventions
vision + podiatry assessment
107
Stroke epidemiological features
>40 yrs old
regional area
108
Stroke aetiology
hypertension
high cholesterol
atrial fibrillation
diabetes
age, gender + fam history
109
Stroke pathophysiology
ischaemic stroke = acute loss of blood flow to brain b/c of infarct (blockage of artery by thrombus or embolus)
haemorrhage stroke = rupture of blood vessel in brain causing brain cells to die b/c of low O2
110
Stroke prognosis
rapid recovery in days following
long recovery in general - better outlook if rehab good
111
Stroke symptoms
face dropped
arms X be lifted
slurred or confused speech
112
Stroke contributing factors
poor diet
low PA
age, gender + fam history
113
Stroke PT Mx
resistance training
things to increase cardioresp fitness
task specific practice
114
Stroke other Mx
must be mobilised in 48hrs unless contraindicated
115
Stroke med Mx
treated by multi D team in stroke unit -> antithrombotic surgery/therapy
116
Parkinson's epidemiological features
60-65 years old
male
gene-environment interactions
117
Parkinson's aetiology
genetically inherited or sporadic (idiopathic)
118
Parkinson's pathophysiology
neurological degeneration of dopamine producing neurons in substantia nigra -> basal ganglia X coordinate movement
119
Parkinson's prognosis
can live long + rewarding life
120
Parkinson's differential diagnosis
multiple system atrophy
progressive supranuclear palsy
basal degeneration
lewy body dementia
121
Parkinson's symptoms
postural instability
tremors
rigidity
bradykinesia
122
Parkinson's specific tests
none, suspected if cardinal signs present
123
Parkinson's diagnostic investigations
MRI + CT scan to rule out other conditions
PET scans w/ fluoro dopa - low levels in striatum
SPECT scans w/ radioisotope
L dopa challenge
124
Parkinson's physio mx
prevent loss of:
- flexibility
- postural control
- limb ROM
125
Parkinson's medical Mx
dopamine replacement via levodopa
dopamine agonists
COMT inhibitors
anticholinergics
deep brain stimulation
126
COPD epidemiological features
1 in 7 over 40 have some form
127
COPD aetiology
smoking
asthma
genetics
exposure to environmental irritants
128
COPD pathophysiology
changes in large + small airways
increased normal inflammatory response
increased number of activated polymorphonuclear leukocytes -> release elastases in manner X counteracted by proteases = lung destruction
129
COPD prognosis
quality of life can be maintained if managed properly
130
COPD symtpoms
worsening dyspnea + exercise intolerance
chronic bronchitis = progressive card/resp failure + weight gain, productive cough + pulmonary infection
emphysema = long standing dyspnea + late onset non-productive cough, cachexia + resp. failure
131
COPD objective exam
chronic bronchitis = obese, frequent cough, use of accessory muscles in resp, wheezing, cyanosis
emphysema = thin w/ barrel chest, breathing assisted w/ pursed lips + accessory muscles, chest hyperresonance
132
COPD tests
spirometry before + after meds
133
COPD physio Mx
action plan to treat exacerbation early through resp physio
134
COPD med Mx
pharmacology or O2 therapy
135
Ankylosing spondylitis epidemiological features
males
15-45 onset
136
Ankylosing spondylitis aetiology
genetic contribution
137
Ankylosing spondylitis pathophysiology
inflammatory arthritis affecting spine + large joints
ossification of ALL.s -> bamboo spine
138
Ankylosing spondylitis prognosis
progressive flexed spinal posture -> secondary breathing difficulties
139
Ankylosing spondylitis dif. diagnoses
rheumatoid arthritis
140
Ankylosing spondylitis symptoms
pain + stiffness in back, buttocks + neck
tendon + lig pain in chest, heel, under foot = enthesitis
eye inflammation
141
Ankylosing spondylitis behaviour of symptoms
inflammation improves w/ exercise
am stiffness >45 mins / improves w/ rest
142
Ankylosing spondylitis tests
X rays
blood tests - HLA-B27, IL23R + ARTS1 genes
143
Ankylosing spondylitis physio Mx
aquatic therapy for spine
144
Ankylosing spondylitis other Mx
rheumatologist to learn about AS
145
Ankylosing spondylitis med Mx
analgesics, NSAIDs, corticosteroids, DMARDs
