EXAM #2 Pathologies Related to UE

Question 1

what is the most common area of metastasis?

Answer 1

lung
esp from colorectal region

Question 2

why is metastasis common?

Answer 2

due to lungs being the first organ to filter malignant cells in vena cava

Question 3

who are at risk for lung cancer?

Answer 3

long term smokers

Question 4

true or false. lung cancer symptoms may not arise until disease is widespread

Answer 4

ture

Question 5

what is the most common symptom for lung cancer along with other respiratory S&S?

Answer 5

cough

Question 6

lung cancer may have _____ P! that can be associated with a ______ tumor

Answer 6

shoulder P!
pancoast

Question 7

lung cancer is what type of referral?

Answer 7

urgent

Question 8

less common lung cancer in the apical region

Answer 8

pancoast tumor

Question 9

who has the highest occurrence of pancoast tumors?

Answer 9

men > 50 years of age with a smoking history

Question 10

S&S of pancoast tumor:

Answer 10

lung cancer S&S
shoulder P! (most common symptom)
compression on subclavian v. –> TOS S&S, ribs, vertebrae, brachial plexus, spinal n –> paresthesia’s along C8 T1

Question 11

what motions would fatiguing weakness and hand atrophy be present at C8 with a pancoast tumor?

Answer 11

ulnar deviation
5th digit flexion

Question 12

what motions would fatiguing weakness and hand atrophy be present at T1 with a pancoast tumor?

Answer 12

2nd digit flexion
thumb flexion/abduction

Question 13

what motions would fatiguing weakness and hand atrophy be present at median nerve with a pancoast tumor?

Answer 13

pronation
wrist flexion
thumb flexion/abduction

Question 14

what motions would fatiguing weakness and hand atrophy be present at ulnar nerve with a pancoast tumor?

Answer 14

wrist flexion
ulnar deviation
4/5th digit flexion

Question 15

pancoast tumor dural mobility may possibly be + for what nerves?

Answer 15

median and ulnar

Question 16

growth of a pancoast tumor may lead to compression on what?

Answer 16

sympathetic ganglion at cervicothoracic junction

Question 17

what are S&S of pancoast tumor?

Answer 17

ipsilateral fascial flushing and sweating
Horner’s syndrome
respiratory S&S are rare due to smaller apical location

Question 18

what is psoriatic arthritis?

Answer 18

a type of spondyloarthropathy or spondyloarthritide

Question 19

what is the cause of psoriatic arthritis?

Answer 19

unclear genetic and environmental factors

Question 20

onset of psoriatic arthritis typically in ____ and ____
less common than _______

Answer 20

30s and 40s
rheumatoid arthritis

Question 21

what is a risk factor for psoriatic arthritis?

Answer 21

psoriasis

Question 22

how does psoriatic arthritis develop?

Answer 22

persistent inflammation targets the entheses and gradually thickens and erodes tissues
fibrous tissue may even fill in the joint space

Question 23

S&S of psoriatic arthritis

Answer 23

spondyloarthritide S&S
dactylitis - inflammation of entire digit
enthesis - DIPs more affected due to greater number of entheses and very little synovial tissue

Question 24

what kind of referral for psoriatic arthritis

Answer 24

urgent referral

Question 25

what do both psoriatic arthritis and rheumatoid arthritis do?

Answer 25

- damage joints causing swelling and stiffness - damage other tissues and organs - auto immune disease - produce auto antibodies

Question 26

what are two differences between psoriatic arthritis and rheumatoid arthritis?

Answer 26

RA attacks synovial joint tissue (MCPs and wrists) PsA attacks entheses (DIPs) RA - bilateral PsA - unilateral

Question 27

what is the prevalence of rheumatoid arthritis?

Answer 27

onset - 30-60s females > males

Question 28

what is the cause of rheumatoid arthritis?

Answer 28

unclear genetic and environmental factors positive rheumatoid factor in blood tests

Question 29

how does rheumatoid arthritis develop?

Answer 29

- auto-immune disease that breaks down all loose connective tissue throughout the body - progresses from cartilage degradation to ligament laxity to thickened synovial tissue and finally erosion

Question 30

what structure is involved in rheumatoid arthritis? it is the most common type of tissue in the body

Answer 30

all loose connective tissue holds organs in place and attaches skin to underlying tissue particularly in synovial membrane of synovial joints

Question 31

what are autoimmune S&S for rheumatoid arthritis?

Answer 31

joint pain and stiffness > 30 minutes in the morning and after prolonged positions reduced grip strength

Question 32

rheumatoid arthritis typically starts in ______ peripheral joints, particularly the ______

Answer 32

smaller hands

Question 33

what are 3 possibilities that rheumatoid arthritis could progress to?

Answer 33

possible tendon ruptures and deformities: synovitis (enlarged finger joints), swan neck and boutonniere deformities, nodules and spurring, ulnar drift at wrist carpal tunnel syndrome may progress to cervical spine

Question 34

what would a PT prescribe for rheumatoid arthritis?

Answer 34

POLICED aggressive stretches contraindicated with advanced cases orthotics/ergonomic education --> unload involved cartilage/support joints, prevent greater deformity/ROM loss JM: cartilage integrity/joint mobility (contraindicated in advanced cases) MET: optimal stresses for cartilage integrity/joint mobility

Question 35

what is the prognosis for rheumatoid arthritis?

Answer 35

progressive secondary OA changes inevitable development of joint instability, of concern in upper cervical spine

Question 36

RA - _______ ________ disease OA - ________ ________ disorder

Answer 36

connective tissue articular cartilage

Question 37

RA affects: OA affects:

Answer 37

joints, muscles, organs, etc only affects joints, primarily weight bearing ones

Question 38

RA symptoms present? OA symptoms present?

Answer 38

symptoms always present, but with exacerbations/remissions symptoms aren't always present

Question 39

RA pain ____ stiffness OA stiffness ____ pain

Answer 39

> >

Question 40

RA edema/effusion in _______ OA edema/effusion ________

Answer 40

extremities localized

Question 41

`RA and OA bilateral or unilateral?

Answer 41

RA: bilateral OA: unilateral