Ankylosing and Infectious Spondylitis Reiter's Multiple Myeloma Metastatic Carcinoma and Abdominal Aneurysm

Inflammatory arthritis that usually affects the SI joint with progressive _____

ankylosing spondylitis

A young man with chronic low back pain and stiffness is an example of _____

ankylosing spondylitis

Ankylosing spondylitis presents with the following physical symptoms _____

occasional radiation into thighs and buttocks, anterior or posterior

Ankylosing spondylitis can have _____

stiffness upon rising and some relief with mild to moderate activity

T/F Ankylosing spondylitis affects men 3x more than women

True

T/F Ankylosing spondylitis is earlier onset the more progressive the disease

True

The one cause of ankylosing spondylitis is _____

Inflammation of the ligamentous insertions

With the progression of ankylosing spondylitis there is stiffening and _____

• loss of lumbar lordosis

• Increased thoracic kyphosis

• Decrease chest expansion due to costotransverse joint involvement

T/F The exact cause of ankylosing spondylitis is unknown, genetic and environmental factors, genetics seem more important

True

3-5% of the time with ankylosing spondylitis _____

heart involvement may lead to AV conduction defects and aortic insufficiency

50% of the time with ankylosing spondylitis _____

peripheral joint involvement occurs

With AS the joints are most affected are the _____

hips, shoulder and knees

If AS is suspected _____

chronic back pain and stiffness with global decrease in ROM

With AS lab testing will revel _____ in 85% of cases

ESR

With AS lab testing will revel _____ in 90% of cases

HLA-B27

AS is a primarily _____ diagnosis

radiographic

For As radiographic changes can take _____ to be visible

4-6 years

On x-ray SI joints show _____

pesudowidening, erosions and sclerosis

In AS lumbar spine shows _____

squaring of lumbar vertebrae, trolly track sign, bamboo spine and eventual fusion

T/F Gentle manipulation can be given to those with inflammation and AS

True

The multimodal management of AS is _____

aerobic exercise, stretching and pulmonary exercise

A young male presents with low back pain that began after an onset of urethritis, conjunctivitis and skin lesions on soles or palms has _____

Reiter’s syndrome

T/F Reiter’s syndrome will be seronegative

True

Reiter’s syndrome occurs following an infection with the following _____

Chlamydia, Campylobacter, Salmonella, Yersinia

1st diagnostic indicator of Reiter’s syndrome

Conjunctivitis resolves 1-2 days

2nd diagnostic indicator of Reiter’s syndrome

Mucocutaneous lesions, tongue, palate, penis or foot

3rd diagnostic indicators of Reiter’s syndrome

Urethritis (usually first symptoms - does not respond to antibiotics)

4th diagnostic indicator of Reiter’s syndrome

Arthritis affecting knees and ankles (SI is most common and motioning of the joint increasing pain

Radiographic indicators of Reiter’s syndrome

subtle SI joint changes early, unilateral, joint narrowing with erosive changes

T/F Antibiotics are effective in managing Reiter’s syndrome

False

T/F Management of Reiter’s syndrome is mostly symptomatic

True

T/F Since it is an inflammatory disease manipulation of SI joint may aggravate the patients symptoms

True

T/F Joint involvement may be progressive and permanent

True

A 50 year old has persistent back pain that is not relieved by rest. Pain is worse at night and he may have rib pain. What is the diagnosis?

Multiple Myeloma

Multiple Myeloma can cause _____

osteoporosis, hypercalcemia, anemia, renal disease and infection

Proliferation of plasm cells with replacement of bone marrow is seen with

Multiple Myeloma

A patient that has Bence-Jones proteins is an indicator for

Multiple myeloma

Monoclonal spiking is seen in

Multiple myeloma

Unexplained back pain, labs and imaging is also seen in

Multiple myeloma

More than 20% of plasma cells are a definitive diagnosis for multiple myeloma. This is able to be found because of a _____

bone marrow biopsy

T/F MM does not affect posterior elements like pedicles

True

With MM what is used to relieve bone pain

Chemotherapy or radiation

What is curative for MM

Bone marrow transplant

T/F manipulation is contraindicated for MM

True

In individual over 50 has insidious pain that is constant and worse at night. They also have a history of weight loss and fatigue. What condition might they have?

Metastatic Carcinoma

With metastatic carcinoma is mechanics affected?

ROM/Ortho’s may be negative

This disease accounts for 1% of low back pain _____

metastatic carcinoma

Metastatic carcinoma are most common from_____

breast, prostate, lung and kidney

metastatic carcinoma involves what part of the vertebrae _____

vertebral body and pedicle

How does a patient with metastatic carcinoma respond to chiropractic treatment?

Non responding to conservative for 4 weeks

Patients with metastatic carcinoma should have the following management _____

Imaging and referral

This patient has not 1 typical presentation of symptoms and a fever may not be present. They do have a key symptom of deep back pain with history of recent respiratory or urination infection or IV drug use and/or diabetes. What condition might the patient have?

Infectious Spondylitis

key history for patients with infectious spondylitis?

Recent respiratory or urinary infection

Pyogenic cause of infectious spondylitis

Staphylococcus, Streptococcus and gram-negative

Non-pyogenic cause of infectious spondylitis

usually tuberculosis but may be brucella or fungi

Infectious spondylitis is spread through what 3 systems?

arterial system, Batson’s venous plexus or directly through surgery

Infectious spondylitis affects both the _____ and the _____.

disc and vertebral body

Adult patients with infectious spondylitis have a history of _____

UTI, IV drug use, skin infections, indwelling catheter post surgery

Children with infectious spondylitis are more prone to _____

discitis

All patients with infectious spondylitis have a history of _____ and _____

fever and difficulty sleeping

Physical exam of a patient with infectious spondylitis will have_____

antalgic and the pain is worse with pressure or percussion of spinous process

Laboratory findings of an increased ESR and occasionally changes in leukocytes are seen with what disease?

Infectious spondylitis

Infectious spondylitis usually involves more than one vertebra and should be referred to who?

spine orthopedics

Patient may present with mild to severe middle abdominal or low back pain. They may have leg pain with exertion. This patient has ______

Abdominal Aneurysm

Atherosclerotic aneurysms occur primarily below the _____

renal arteries

T/F Abdominal aneurysms are more predominant in male patients

True

What is an important risk factor for abdominal aneurysm?

Smoking

Abdominal aneurysm can be casue by _____

• Trauma

• Degeneration of aorta

• Post surgical disruption

• Vasculitis

Vasculitis is _____

Inflammation of aorta and branches Takayasu arteritis

For the evaluation of an abdominal aneurysm in asymptomatic patients you should _____

pulsatile mid or upper abdominal mass

palpation of an abdominal aneurysm is most sensitive when an aneurysms is ____

> 3cm

Auscultation may reveal a _____

bruit

T/F Peripheral pulses may be prominent

True

The evaluation of abdominal aneurysm is seen on what type of x-ray _____

Lateral lumbar

On a lateral lumbar x-ray what is seen

calcified margins

During a chiropractic evaluation the history _____

ID’s risk factors

During a chiropractic evaluation the physical exam will ____ for an abdominal aneurysm.

feel pulses in the lower extremity

The physical exam portion of a chiropractic evaluation of an abdominal aneurysm will also include _____.

auscultation of AA for bruit (bell) and palpation of AA for thrill using the tips of fingers

The preventive services task force for AAA recommends how many ultrasounds?

one

An ultrasounds for AAA is suggested for what people?

current or former male smokers aged 65 to 75 years

The preventive services task force recommendation has now expanded to include _____.

men and women with a family history of AAA

Management of an AAA includes _____

an abdominal ultrasound

Abdominal aneurysms 4-6 cm in size should have a ____

surgical consultion