Other System Pathologies

Question 1

Ankylosing Spondylitis

Answer 1

• progressive systems disorder characterized by inflammation of spine and larger peripheral joints.
• Joints: SI, IVD, spine, costovertebral and apophyseal joints, connective tissues, lg peripheral joints (hips, knees, and shoulders)
• HLA-B27 histocompatibility has a high risk for the disease
• Caucasian males b/n 20-40
• S&S:
• Early AS: recurrent and insidious episodes of LBP, morning stiffness, impaired spinal extension, and limited ROM over 3 mth period of time
• Severe AS: severe pn, consistent, pn extending to midback and sometimes neck., flattened lumbar curve (from m spasms)
• Fixed flexion at the hips, spinal kyphosis, fatigue, weight loss, and peripheral joint loss.
• Longtime AS: Iritis, uveitis, osteoporosis, fx, AA subluxation, and complete spinal fusion.
• pericarditis, cardiac pathology, pulmonary fibrosis, cardiac arrhythmias, amyloidosis, and aortic insufficiency
• Diagnosis: X-ray may be negative initially….then show areas of erosion, demineralization, calcification, syndesmophyte formation, leading to fusion.
• Treatment:
• NSAIDs, DMARDs (methotrexate), analgesics, and specifically indomethacin (for pain relief)
• PT: emphasize extension, general ROM, pain, aerobic exercise (extension and rotation)

Question 2

Astrocytoma

Answer 2

• Accounts for ~50% of pediatric brain tumors.
• Etiology - Genetic predisposition, environmental influence, radiation and toxin exposure, and association with certain childhood disorders.
• Signs and symptoms - 2 types
• Cerebellar - clumsiness, ataxic gait, headache, change in personality, and vomiting
• Supratentorial - headache, seizures, change in personality, visual impairments, and vomiting
• Treatment -
• Surgical resection of cerebellar tumors offers an 80-90% cure rate.
• Supratentorial tumors also require surgery to resect the tumor with radiation and/or chemotherapy.

Question 3

Brain Cancer

Answer 3

• A primary tumor arising from astrocytes, meninges, nerve cells, or tissues within the brain.
• Metastatic brain cancer occurs when a brain tumor develops as a consequence of cancer in another primary area of the body.
• Etiology - Most primary cancers outside of the brain metastasize to the brain during progression of the cancer.
• Signs and symptoms -
• typically progress rapidly.
• HA, seizures, increased ICP, cognitive and emotional impairment, and decreased motor and sensory function.
• Treatment - Surgical resection along with radiation or other combined therapies are typically indicated.

Question 4

Breast Cancer

Answer 4

• Most common female malignancy (typically over the age of 50), but can also occur in men.
• Majority of cases are classified as adenocarcinoma and it is the 2nd leading cause of female death from cancer.
• Common metastases: lymph nodes (lymphatic system), lungs, bones, skin, and brain. If the cancer recurs, it is usually within 2 yrs of the initial diagnosis.
• Etiology - Risk factors include genetics, gender, age, menstrual history, and geography.
• estrogen is believed to have some relationship to the disease process
• young menarche, late menopause
• Gender, age, family hx, high alcohol intake, high fat diet, radiation exposure, and past hx of CA
• Signs and symptoms -
• Lump and is usually found by the woman. (typically firm, irregular, and non-painful).
• The patient may also present with signs including nipple discharge, erythema or a change in breast shape.
• Treatment
  -Treatment may include surgery, radiation,
  chemotherapy or hormonal manipulation.
• Curable if diagnosed prior to metastases; survival rate decreases as the stage of the cancer increases. - The current 5-year survival rate for localized tumors is 92%; this drops substantially if there is nodal involvement.

Question 5

Cervical Cancer

Answer 5

• Starts in the cells on the surface of the cervix, typically squamous cells.
• Precancerous condition is called dysplasia and is easily treatable.
• Annual cervical screening is recommended; diagnosis is made through a Pap test (smear).
• Prognosis is good with timely intervention. If dysplasia goes undetected, changes can develop into cervical cancer and metastasize to the bladder, intestines, lungs, and liver.
• Etiology -
• The HPV is the primary cause of cervical cancer; it is slow growing.
• Risk factors: smoking, maternal use of diethylstilbestrol (DES), African American ethnicity, oral contraceptive use, and certain sexually transmitted diseases.
• Signs and symptoms -
• Asymptomatic during the early stages
• Abnormal bleeding, pelvic and low back pain, impairment with bladder and bowel function.
• Treatment - Treatment is dependent on staging of the cancer and may include laser therapy, excision, cryotherapy or hysterectomy with adjunct chemotherapy or radiation.

Question 6

Chronic Fatigue Syndrome

Answer 6

• Complex condition with unknown etiology that is considered diagnosis of exclusion
• Etiologies (potential): viral origin, an immune response to inflammation within the nervous system.
• Risk Factors: environmental and genetic influences, viral infection, immunological dysfunction, nutritional deficiency, hormonal imbalance, depression, anemia, allergens, hypotension, and autoimmune response.
• Clinical presentation: (have to meet specific criteria….the first one and 4-8 of the additional ones)
• hx of at least 6 mths of unexplained, prolonged, and severe fatigue that is not relieved by rest
• self-reported memory or concentration deficits sever enough to interfere with ADLs
• persistent or recurrent sore throat
• painful or enlarged axillary or cervical lymph nodes
• unexplained m pain
• migrating joint pain without visible signs of inflammation
• complaints of malaise lasting >24 hr after physical or mental exertion
• HA that exhibits changes in pattern and severity
• Treatment:
• Pharm: symptom-based and psychothearpy
• PT: relaxation techniques, energy conservation, exercise
• have low tolerance for physical exertion (but if they avoid it…symptoms get worse)…so low level short duration with gradual progression.

Question 7

Colorectal Cancer

Answer 7

• Start as a growth on the inner lining of the colon or rectum (i.e., polyp).
• Some polyps can change into cancer over time, while others do not. Adenocarcinoma and primary lymphoma account for the majority of intestinal cancers.
• Etiology - Risk factors include increasing age, history of polyps, ulcerative colitis, Crohn’s disease, family history, and a diet high in fat and low in fiber.
• Signs and symptoms -
• does not provide early signs of disease and the most prominent symptom is a continuous change in bowel habits.
• Bright red blood from the rectum
• Fatigue, weight loss, anemia, and overt rectal bleeding.
• Treatment -
• based on the type and staging of the cancer and may include surgical resection of the tumor and potentially a portion of the bowel, with subsequent radiation therapy and/or chemotherapy;
• colostomy may be required.
• Prognosis is good for early diagnosis if the cancer is contained (prognosis is poor if it has metastasized)

Question 8

Electrolyte Imbalances

Answer 8

• minerals that carry an electrical charge and are present within the fluids of body
• critical to many of the body’s processes (nerve and m function and maintenance of fluid balance)
• Several causes: meds, vomiting, diarrhea, inadequate diet or malabsorption, trauma, burns, CA, thyroid disorders, endocrine or metabolic disorders, renal disease, liver disease, CHF, alcoholism, and eating disorders
• Which minerals are most common:
• Ca+, Cl-, Mg+, phosphate, K+, and Na+
• S&S:
• dizziness, fatigue, nausea, constipation, diarrhea, decreased urine output, dark urine, dry mouth, decreased perspiration, m weakness, m cramping or spasm, irregular heartbeat, and HA.
• Signs of dehydration: change in mental status, poor skin elasticity, rapid heart rate, sunken eyes

Question 9

Fibromyalgia Syndrome

Answer 9

• rheumatology syndrome or a nonarticular rheumatic condition.
• Pain is the primary symptoms by tender points within m, tendons, and ligaments.
• Etiology: biochemical, metabolic or immunologic pathology.
• Clinical incidence: Females 14-68.
• widespread hx of pain that exists in all 4 quadrants of the body.
• Fatigue, memory and visual impairment, sleep disturbances, IBS, HA, and anxiety/depression
• Treatment:
• Physician: address sleep disorders and the other symptoms.
• Psychotherapy: anxiety, depression, incorporate stress management, coping strategies.
• PT intervention: include relaxation techniques, energy conservation, gentle stretching, moist heat, ultrasound, posture and body mechanics, biofeedback, and exercise to tolerance.
• Aquatic therapy to improve a patient’s fitness level and an ergonomic evaluation should be performed at the patient’s work place.
• Should not work through pain.
• Require short exercise sessions initially (3-5 min) due to a low tolerance for exertion.

Question 10

Leukemia

Answer 10

• Cancer of the blood that occurs when leukocytes change into malignant cells.
• Immature cells proliferate, accumulate in bone marrow, and ultimately cease the production of normal cells.
• Process will spread to lymph nodes, liver, spleen, and other areas of the body.
• Many types: acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML) occurring most frequently in children.
• Etiology - Environmental, chemical or toxin exposure, genetic predisposition, and viral association.
• Signs and symptoms -
• Abrupt onset with high fever, bleeding, enlarged lymph nodes and spleen, progressive weakness, fatigue, and painful joints.
• Blood work will indicate anemia, a leukocyte count greater than 500,000 mm3 and thrombocytopenia.
• Treatment -
• Options include immunotherapy, cytotoxic agents, chemotherapy or radiation, and bone marrow transplant.
• Over 90% of patients with (ALL) achieve complete remission with treatment, while 70-80% of patients with (AML) achieve complete remission with treatment.

Question 11

Lung Cancer

Answer 11

• Cancer of the epithelium within the respiratory tract.
• Most frequent cause of death from all cancers.
• Rapid metastasis: pulmonary vascular system, adrenal gland, brain, bone, and liver.
• Etiology - Risk factors include smoking, environment, geography, occupational hazards, age, and family history.
• Signs and symptoms -
• Early symptoms include cough, sputum, and dyspnea.
• Progression may include symptoms of adventitious breath sounds, chest pain, and hemoptysis.
• Treatment -
• Poor prognosis secondary to expedited metastasis (less than 14% for a five-year survival rate).
• Surgical intervention along with combination therapies may be required.

Question 12

Lymphoma

Answer 12

• Cancer found in the lymphatic system and lymph tissues;
• Categorized as Hodgkin disease or non-Hodgkin lymphoma.
• Etiology
• Risk factors for Hodgkin disease include association with Epstein-Barr virus, drug abuse, immunosuppressant use, obesity, chronic or autoimmune diseases.
• Risk factors for non-Hodgkin lymphoma include exposure to benzene (i.e., cigarette smoke), auto emissions, and pollution.
• Signs and symptoms -
• A painless lump is typically the first sign and general symptoms include fever, chills, and fatigue. - Hodgkin disease is distinguished by the presence of Reed-Sternberg cancer cells. Both forms can metastasize.
• Treatment -
• Hodgkin disease is one of the most curable cancers depending on age, disease stage, overall health, and responsiveness to treatment.
• Treatment options are based on the patient’s age and staging classification and include chemotherapy, radiation, Stem cell transplant, and highly active antiretroviral therapy.
• Non-Hodgkin progression varies based on classification, co-morbidities, and treatment response.

Question 13

Multiple Organ Dysfunction Syndrome

Question 14

Neuroblastoma

Answer 14

• Tumor that initiates from primitive ectodermal cells of the neural plate and is found within the sympathetic nervous system, primarily seen in the adrenal glands or paraspinal ganglia.
• Most common malignant tumor seen in children.
• Etiology -
• Remains unknown,
• Causative factors include genetic predisposition, familial incidence, environmental influence, radiation and toxin exposure or viral association.
• Signs and symptoms -
• Abdominal mass, change in personality, anemia, sweating, pain, and diarrhea.
• Treatment -
• Surgical resection, chemotherapy, and radiation.
• Prognosis is best for children diagnosed in the first year of life.
• A neuroblastoma will spontaneously regress in rare cases.

Question 15

Osteogenic Sarcoma

Answer 15

• Cancer that occurs at the epiphyses of long bones.
• Most common form of bone cancer in children with a peak incidence between the ages of 10 and 20.

Etiology - unknown
- correlation between immune incompetence and rate of tumor progression.
- Can metastasize quickly.

Signs and symptoms -
- Presence of a mass, rapid metastases, and associated pain.
- Diagnosis can be made with a biopsy.

Treatment -
- Treatment includes amputation with proximal resection to ensure proper removal of affected tissue or surgical procedures that attempt to resect the tumor and salvage the limb.
- Chemotherapy is beneficial, however, radiation is not effective with this type of tumor.

Question 16

Pancreatic Cancer

Answer 16

• Prominent type of cancer with an extremely high mortality rate.
• Cancer of the exocrine cells within the ducts is the most common form of pancreatic cancer.
• Metastasize to the liver, lungs, pleura, colon, stomach, and spleen.
• Etiology -
• Risk factors include tobacco use, gender, increasing age, and cholecystectomy.
• Signs and symptoms -
• Vague during the initial stages of the disease which often results in delayed diagnosis.
• Weight loss, jaundice, and epigastric pain that can radiate to the thoracic region.
• Advanced cancer may present with severe pain that may indicate the cancer has metastasized.
• Treatment -
• Treatment is usually directed to assist in the relief of symptoms.
• Very poor survival rate with a mortality rate of almost 100%.
• Surgical resection along with chemotherapy and radiation assist to relieve symptoms.

Question 17

Prostate Cancer

Answer 17

• Adenocarcinoma is the most common type of prostate cancer.
• Men over 50 years old
• It is the 2nd highest cause of death from cancer in men.
• Diagnosis -prostate biopsy and prognosis is good with appropriate treatment.
• ~10% fatality from this diagnosis.
• Etiology - Risk factors include increased age, high fat diet, genetic predisposition, African American descent, and exposure to cadmium.
• Signs and symptoms -
• Asymptomatic until the cancer reaches the advanced stages.
• Urinary obstruction, pain, urgency, and decreased stream/flow of urine.
• Treatment -
• Surgical incision of the prostate gland, radiation, or hormonal therapy;
• Can metastasize to the bladder, musculoskeletal system, lungs, and lymph nodes.

Question 18

Complex Regional Pain Syndrome

Question 19

Basal Cell Carcinoma

Answer 19

• Slow growing form of skin cancer that rarely metastasizes.
• It originates from the epidermis and is the most common form of skin cancer.
• Etiology -
• Sun exposure is a common cause,
• Risk factors: frequent sun exposure, light eyes, and fair skin.
• Signs and symptoms -
• Open sores that can bleed or crust and remain for three or more weeks,
• Reddish patches of skin,
• Shiny bump on the skin that is often pink,
• A scar-like area that has poorly defined borders
• Treatment -
• Prognosis is good;
• basal cell carcinoma can routinely be cured. Surgical excision may be required to remove the cancer cells.

Question 20

Malignant Melanoma

Answer 20

• Originates from melanocytes and can be classified as: superficial spreading, nodular, lentigo maligna or acral lentiginous melanomas.
• Peak incidence: 40-60 years of age.
• Early diagnosis is vital to prognosis, as it can spread and metastasize quickly.
• Metastases: brain, lungs, liver, bone, and skin.
• Etiology - History of blistering sunburns prior to 20, family history, immunosuppression, light eyes, fair skin, and a previous history of cancer.
• Signs and symptoms -
• Lesions can be elevated on the surface of the skin and appear keratotic or scaly.
• Asymmetry, irregular borders, varied color, and a diameter of greater than six millimeters. (ABC)
• Treatment -
• This form of cancer is 100% curable with early diagnosis.
• Excision may solely be required with early treatment.
• If melanoma has metastasized, surgical intervention along with combination therapies may be required.

Question 21

Systemic Lupus Erythematosus (SLE)

Answer 21

• Connective tissue disorder caused by an autoimmune reaction in the body
• Females are at greater risk than males with the most common age group ranging from 15-40 y/o

Clinical presentation:
- butterfly rash across nose and cheeks
- red rash over light exposed areas
- arthralgias
- alopecia
- pleurisy
- kidney involvement
- seizures
- depression

Question 22

Systemic Sclerosis (Scleroderma)

Answer 22

• autoimmune diffuse disease of connective tissues.
• Causes fibrosis of skin, joints, blood vessels, and intenral organs.
• also has raynauds phenomenon

Question 23

Wilm’s Tumor

Answer 23

• Embryonal nephroblastoma found in the kidney.
• Diagnosed b/n 1-4 years of age.
• Etiology - Genetic inheritance as an autosomal dominant disease or a non-inherited form with an unknown etiology.
• Signs and symptoms -
• Characteristics include an abdominal mass, pain, hematuria, fever, nausea, and vomiting.
• Treatment -
• Treatment includes resection of the kidney and the associated lymphatic tissue followed by chemotherapy and/or radiation.
• Dactinomycin is also administered due to the drug’s antitumor properties.
• The five-year cure rate is approximately 75%.

Question 24

What is the main treatment approach for multiple myeloma for PT?

Answer 24

• Main symptoms are fatigue, bone pain, and muscular weakness.
• Can lead to skeletal muscle wasting an risk of pathological fracture
• PT: minimize effects of cancer and maintain function and strength
• Low-level exercise and fall prevention to help avoid pathological fractures

Question 25

What makes HIV patients at a higher risk of opportunistic infections?

Answer 25

Neutropenia (decreased leukocytes...aka white blood cells) Places a patient at risk for developing a serious infection. The longer the neutropenia exists, the more likely the patient is to develop a significant infection