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nsm 1 notes

questions from notes

questionanswer
sexually transmitted ds assoc with Reiter's syndrome: chlamydia; shigella and rarely salmonella or yersinia with fecal exposure
other manifestations of Reiter's besides triad: circinate balanitis, keratodermia blennorrhagicum and oral lesions
Where does Reiter's syndrome arthritis affect? knees, ankles and feet
Is HLA in Reiters? yes in 75%
Osteochondroses ds's: Legg-Calve-Perthes, Osgood Schlatter, Freiberg's, Kohlers, Kienbochs, preisers, panners, sever's
Legg-Calve-Perthes ds sx (AKA juvenile coxa plana) avasc nec of cap fem epiph; 3-12 yrs, male; bilateral (10%); insidious, traumatic or inflammatory
What are Legg sx seen in later stages: sudden onset, referred knee px, pxful or pxless limp, limited mvmt (esp rot, abd, flx), px worse w/activity, disuse atrophy, appearance of leg deficiency, DJD later in life
How does Legg start? infl for 2wks-2mths, fx of epiphysis (seen as bulging jt capsule on xray)
How does stage 2 Legg look on xray? opacity & flattening, physis widens and irregular (snow cap sign)
Tx for Legg: minimizing discomfort and deformity-slings, braces & crutch devices
What is Chandler's ds: adult onset AVN of the femoral head
Causes of Chandlers: mc related to chronic alcoholism and long-term steriod use; 5 S's=sterno, steroids, scuba divers, sickle cell anemia, SLE
Sx of Chandlers pxful, dec ROM of hip & affected lower ext; abrupt onset
Course of Chandlers heals spontaneously w/ deformity
Osgood Schlatter sx very common, post-traumatic, traction of AVN of ant tib epiphysis; 10-14 yrs
Pain findings with Osgood: can be bilateral, swollen tender area, px upon resisted ext of the leg
Osgood on xray: prox segment fails to unite with tibial shaft and remains mobile
Osgood tx avoid physical stresses; use of compression supports are very effective
AKA for scheuermann's ds juvenile kyphosis dorsalis; juvenile discogenic ds
Is scheuermann's an AVN? no, not a true one
What is scheuermann's? very common; young person's first chiro visit, d/t congenital weakness of cartilaginous endplate complicated by excessive physical stress. Ends with cessation of growth.
Sx of scheuermanns: low grade back px, stiffness and poor posture mc
xray of scheuermanns multi-level vertebral end plate irregularity and sclerosis, dec disc ht, loss of ant vertebral body height creating "trapezoid-shaped segments", schmorl's nodes; hyperkyphosis
tx of scheuermann's manual therapy, ext back exercises and postural training to relieve discomfort and stiffness. Bracing to minimize deformity in severe cases.
Created by: pcelvfrdm