E2-Immune System-Horners Syndrome Flashcards
what is an innate cell
non specific from birth
monocytes, neutrophils, basophils, mast cells, natural killer cells
what are adaptive cells
acquire following exposure
remember foreign invaders
B and T cells/lymphocytes
what are macrophages and dendritic cells
innate and adaptive cells
where do stem cells occur and what do they generate
bone marrow
immune cells
what are neutrophils
predominantly leukocyte or WBC
1st cells to arrive
phagocytosis
what are monocytes and macrophages
long lived
monocytes mature into macrophages
filter pus/bacteria from neutrophils and kill larger pathogens
what are eosinophils
next cells to participate
handle larger invading pathogens
what do eosinophils release
histamine- vasodilator to improve circulation
what are B lymphocytes
produce antibodies in reaction to antigens or foreign bodies
what are T lymphocytes
stimulate B lymphocytes that are directly kill infected host cells
what are presenting antigens
they present antigens to T lymphocytes to ingest/digest pathogens
what are natural killer cells
large lymphocytes
directly kill cells infected by pathogens
activate macrophages
what is our first line of defense
innate cells
resolve most threats
external/internal defenses
what are our external defenses
physical, chemical, and mechanical barriers that limit host penetration
skin, mucus, coughing, sneezing, stomach acid, etc
what are our internal defenses
soluble factors- modify cell behavior and enhance inflammatory response
innate cells and components from birth
what is our 2nd line of defense
inflammatory response
vascular response and plasma protein systems
what is the vascular response
activated at time of injury or exposure
series of vascular and cellular activities
possibly start a fever
natural killer cells
what is the plasma protein systems
clotting to control bleeding
kinin
what is kinin
produces vasodilation and vascular permeability
makes debris/pathogen vulnerable to phagocytosis
what is the 3rd line of defense
adaptive immunity
what is adaptive immunity
acquired and reactive
characterized by specificity and memory of a pathogen- B/T cells
days to weeks to respond
develops throughout life
responds with exposure
what is active immunity
concept of most vaccinations using a harmless virus to produce a secondary immune response with antibodies and memories
what is passive immunity
passing of antibodies through birth/breast feeding but is only temporary due to lack of memory cells
what is cell mediated immunity
not involving antibodies but instead cells like WBCs and B and T cells that can kill antigens
what are the phases of the immune response
recognition phase
amplification phase
effector phase
termination phase
memory
what factors negatively affect immunity
aging
hormonal imbalances
environment pollution
trauma or illnesses
inadequate sleep
lack of exercise
stress
dysfunctional gut
how does exercise affect immunology
enhanced or suppressed
moderate intensity is beneficial
overtraining without adequate recovery can impair immunity
what is a primary immunodeficiency disease
genetic defect involving T cells, B cells, or lymphoid tissues
what is secondary immunodeficiency
results from an underlying disease or factor that depresses or blocks the immune response
most common
what is acquired immunodeficiency syndrome (AIDS)
massive destruction of the immune system by HIV
what is AIDS patho
HIV depletes T lymphocytes along with other immunity cells
very high mutation rate
what are the S&S of AIDS
constitutional S&S
distal peripheral neuropathy, balance/gait deficits, myalgia and arthralgia, bone degradation
integumentary breakdown
lipodystrophic syndrome
what conditions can increase morbidity and mortality in AIDS
cardiopulmonary
what is lipodystrophic syndrome
central fat accumulation in neck and trunk but a decrease in extremities
what are the PT implications for AIDS
unrestricted with usual benefits for initial asymptomatic HIV
more limited with symptomatic and advanced HIV= less beneficial
What is chronic fatigue syndrome
Immune dysfunction syndrome characterized by unexplained fatigue >4 months limiting ADLs
What are the risk factors for chronic fatigue syndrome
Minority females with lower socioeconomic status
Immune deficits
Traumatic events
Poorly managed stress
Abnormal neuroendocrine function
What are the S&S of chronic fatigue syndrome
Varied
Overwhelming fatigue
Muscle pain and weakness
Forgetfulness
Hypotension that worsens through the day
What are the PT implications of chronic fatigue syndrome
Lifestyle management for stress, sleep, diet, actively levels
Gentle graded exercise
What is hypersensitivity disorder
Inaccurate response of the immune system
No response the first time, but occurs 2nd exposure
What is type 1 hypersensitivity disorder
Immediate type
Seasonal or food allergy
Anaphylactic or severe
What is type 2 hypersensitivity
Tissue or organ specific
Autoimmune condition- tissue and it’s cell function are diminished
Antibody binds to antigen on tissue or cell surface
What is type 3 hypersensitivity
Immune complex mediated
Antibody binding to antigen and then released in circulation
Systemic lupus erythematosus attacks immune tissue throughout the body
Tissue but not organ specific
What is type 4 hypersensitivity
Cell mediated immunity
Only hypersensitivity not involving antibodies
T lymphocytes are present and kill target cells it does not recognize
Graft rejection, RA, MS, diabetes, contact allergen
What is autoimmune diseases and RF
Can’t distinguish body from non self
Genetic
Hormonal
Environment
Infections
What are the S&S of autoimmune diseases
GI S&S
Gradual onset
Inflammation
Swollen lymph nodes
Affects more than 1 area of body
Emotional changes
What are PT implications of autoimmune diseases
Infection control
Exercise prescription
Nutritional guidance
Sleep health
Corticosteroids medications
What are the side effects for corticosteroid medications in PT setting
Bone loss
More susceptible to fx, osteoporosis, avascular necrosis
Offset ideally with WB and resistance exercises
Avoid jt mobilization
Decrease healing
Increase susceptibility to infection
what are the RF and S&S for lupus
primarily young women and minorities
all systems maybe involved
what are the PT implications for lupus
protection with bracing/assistive devices
energy conservation
monitor symptoms
gentle and regular exercise
what is spondyloarthropathies or spondyloarthritides
group of diverse autoinflammatory conditions that affect the spine more than extremity jts
what are the common features of spondyloarthropathies or spondyloarthritides
gradual onset
> 30 minutes of P! after prolonged positions
chronic inflammation of axial skeleton
extraarticular involvement- eyes, skin, GI tract, renal and cardiac
what are the RF for sjogren syndrome
postmenopausal women
what is the patho of sjogren syndrome
exocrine glands, mainly salivary and lacrimal glands destruction
what are the S&S of sjogren syndrome and the hallmark
spondyloarthritide S&S
peripheral neuropathy due to vasculitis
fatigue
sleep disturbance
DRY EYES AND MOUTH
what is fibromylagia
chronic widespread myalgia
what are the RF of fibromyalgia
women
20-55 yrs
minimal fitness levels
what can trigger fibromylagia
prolonged anxiety and stress
trauma
rapid steroid withdrawal
thyroid disorders
infections
what is the patho of fibromyalgia
misprocessing of pain with sensitization and nociplastic pain
micro spasms of muscles - impaired circulation and fatigue
hypothalmic pituitary adrenal gland dysfunction - response to stress
how does the ANS respond to fibromyalgia
hyperactive flight or fight
hypoactive parasympathetic
increase of immune cells
how does pain affect immune system
more cells = more release of pain neurotransmitters = same nociplastic pain response
what are the results for test and measures with fibromyalgia
all imaging and blood tests are negative
Dx by exclusion
how would we treat fibromyalgia
pt education and exercise prescription
what is the MET for fibromyalgia
low to moderate global aerobic and resistance exercise
2-3x/wk
60-90 min
> or = to 13 weeks
what are PT implications for fibromyalgia
nutritional guidance
stress management
minimal benefits
what is multiple sclerosis
chronic and progressive neurodegenerative disorder of the CNS
what is MS RF
white females between 20-50 years
autoimmune response
genetic link
what is MS patho
demyelination
block neural transmission
What are the S&S of MS
specific to CNS involvement
exacerbations and remissions
FATIGUE
optic neuritis
what is the 1st S&S to be manifested with MS
optic neuritis
what gives a sudden transient shock pain to the face
trigeminal neuralgia
what are the neuromusculoskeletal S&S
abnormal speech or swallowing
incoordination and muscle tone
bowel and bladder
sexual dysfunction
what are the S&S found in the scan for MS
resisted testing with multiple jt weakness
neuro tests - UMN findings
what special tests can be done to confirm MS
balance
central vertigo
lhermitte sign
what is our course of Rx for MS
urgent referral
what is the etiology of CVA
ischemic and hemorrhagic
what is the leading cause of long term disability
CVA
what are the nonmodifiable RF for CVA
age
african americans
women
what are the modifiable RF for CVA
CV disease and HTN
diabetes
lifestyle
what is CVA
disrupted blood flow to the brain
what are the S&S of CVA
all SUDDEN onset
multisegmental hemi face
visual disturbance
speech and swallowing impaired
severe headache
unexplained dizziness or falls
what is found in scan for CVA
resisted testing with multiple jt weakness
neuro tests - UMN findings, hyperreflexive/clonus
what is our course of Rx for CVA
EMERGENCY
what can cause posterior circulation compromise
CVA
patho jt instability
atherosclerosis - ICA
sudden arterial dissection
tumors
VBI
presyncope
what artery supplies the trigeminal n
basilar
what are the 5 D’s And 3 N’s
dysphagia
dysarthria
diplopia
dizziness
drop attacks
Ataxia - incoordination
headache
nausea
nystagmus
numbness
what is our course of Rx for posterior circulation compromise
emergency
what is presyncope dizziness
near fainting and lightheadedness without the spinning
what can cause presyncope dizziness
stress or medications (cardiovascular)
what are the S&S of dizziness presyncope
generalized weakness
giddiness
pallor
5 D and 3 N
what is our course of Rx for dizziness presyncope
emergency
what is vertigo
the illusion of spinning or rotary motion
what is peripheral vertigo
BPPV
crystals become from free floating in semicircular canals
what is primary central vertigo
CVA or tumor
what is secondary vertigo
trauma creating brain injury
infection
demyelination
migraine
what is central vertigo patho
due to ischemia to cerebellum, brainstem, vestibular
what are the S&S of peripheral vertigo
severe nausea
greater spinning primarily with horizontal nystagmus
worse with head movements
hearing loss
refer to vestibular PT
what are S&S of central vertigo
UMN signs including 5 D and 3 N
severe perception with linear perception
vertical nystagmus
occurs at rest
severe imbalance
emergency
what is BPPV
most common type of peripheral vertigo
why is central vertigo an emergency referral
due to ischemia to cerebellum, brainstem, and vestibular neclei
what is dysequilibrium
unsteadiness without illusion of spinning
what are the 3 primary systems affected during dysequilibrium
proprioception
vestibular
visual
what can cause dysequilibrium
brain degeneration
aging
neuromusculoskeletal diseases
what do we do for dysequilibrium
assess/treat any MSK condition to improve somatosensory function and balance triad
potential urgent referral for vestibular or vision
what is non specific dizziness
may be due to psychophysiological or cervical origins
how can psychophysiological cause dizziness
vasoconstriction with SNS response
what are the S&S for psychophysiological dizziness
motion sickness
giddiness
feeling removed from the body
sensation of floating
subjective postural balance with normal balance tests
what is the Rx for psychophysiological dizziness
urgent referral to psych
what can cause cervicogenic dizziness
C2-3 dysfunction
abnormal afferent signals from neck to trigeminal nucleus
what is the S&S for cervicogenic dizziness
dizziness with neck motion
head and face parasympathetic symptoms
no illusion of spinning or nystagmus
what is cervical myelopathy
slow gradual and often progressive compression on cord
what can cause cervical myelopathy
lax and buckling lig flavum
ARJC
ARDC
vertebral body collapse
what are S&S of cervical myelopathy
multiple directions of weak and painful resisted testing
wide based gait
incoordination
Cooks CPR +
how do we treat cervical myelopathy
emergency referral with immobilization
what is meningitis
infection leading to inflammation of the brain and spinal cord meningeal membrane
what can meningitis cause that can affect the cord
scar tissue that restricts CSF that can lead to hydrocephalus or decreased blood flow leading to a stroke
what are the typical S&S for meningitis
constitutional S&S (fever and N&V)
neck pain and stiffness
photophobia
HA
what are the S&S for intracranial pressure
altered mental status
cranial n deficits
seizures
motion of bending over, lying down, lifting heavy weight
what are the S&S of viral meningitis
infection and GI
what are the S&S of bacterial meningitis
infection and respiratory
what test to rule out meningitis
jolt accentuation of HA test
HA worsened by neck RT (2-3 turns in a sec)
what test to rule in meningiits
Kernig- low back and posterior thigh pain combined with hip flexion and knee ext
Brudzinski- neck flexion produces hip and knee flexion
how do we treat meningitis
emergency referral
where can the brain tumor come from
lung- most common
breast and skin
what can the brain tumor do
compression of cerebral tissue
at times erosion of bone with growth
edema and intracranial pressure
what are the S&S for brain tumor
cancer S&S
HA increased with activity (looking down, coughing, straining, exercise)
ataxia
diplopia
painful eye motion
tinnitus
seizures
speech impairment
what causes horners syndrome
pancoast tumor in apical of lung that compresses the sympathetic ganglion at cervicothoracic junction
what does the the compression of the sympathetic ganglion in horners syndrome cause
interruption of sympathetic n supply to the eye
what are the S&S of horners syndrome
unilateral
ptosis
lack of face sweating
sunken eyeball
miosis
possibly pain at top of shoulder
