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PTA 202 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What percent of LE amputations are proceeded by a foot ulcer?

A

85%

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2
Q

54% of amputations are do to what?

A

PVD and or diabetes

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3
Q

What is the most common type of amputation?

A

Below knee (transtibial)

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4
Q

Arterial Vs. Venous

A

-Arterial: oxygenated blood flowing away from the heart to the body
-Venous: de-oxygenated blood flowing from the body to the heart

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5
Q

What is the term for when a thrombus or embolus suddenly blocks blood flow in one of your peripheral arteries?

A

Acute Arterial Occlusive Disease

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6
Q

What is the term used to describe a slow buildup of plaque in the peripheral arteries which blocks blood flow?

A

Chronic Arterial Insufficiency

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7
Q

What is the diagnosis given to those with a chronic arterial insufficiency?

A

Atherosclerosis

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8
Q

What is intermittent claudication?

A

Ischemia with activity

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9
Q

What portion of the ankle are Arterial Ulcers found and what are their characteristics?

A

-The lateral portion of the ankle, dorsum of foot, or toes
-Smooth, defined edges
-Deep
-Pain with elevation

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10
Q

Should you elevate or compress an Arterial Ulcer? Why or why not?

A

No, you want blood from the heart to get to the limb being restricted of blood flow

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11
Q

These are characteristics of which condition?
-Inflammation of the small and medium sized arteries and veins
-Occurs mainly in men who smoke
-Bilateral ischemia
-Sx are reversible with smoking cessation

A

Thromboangiitis Obliterans (Buerger’s Disease)

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12
Q

SVT vs. DVT

A

-SVT: clots in the veins near the surface of the skin and can be painful to touch
-DVT: clots in the deep veins of the body and are at risk of turning into an embolus

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13
Q

What is the Homan’s Sign used for?

A

To detect a DVT

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14
Q

Which form is a better predictor for a DVT than the Homan’s Sign test?

A

The Wells Clinical Prediction Rule for DVT

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15
Q

What portion of the ankle are Venous Stasis Ulcers found and what are their characteristics?

A

-The Medial portion of the ankle (medial malleolus)
-Irregular shaggy edges
-Shallow
-Pink or red if not infected
-Pain in dependent position
-Edema

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16
Q

Should you elevate or compress a Venous Stasis Ulcer? Why or why not?

A

Yes, because you want the buildup of blood and fluid in the LE to go back to the heart

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17
Q

Does a person’s pulse give a good indicator of a person’s arterial or venous blood flow?

A

Arterial

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18
Q

What grade is given to a normal strength pulse?

A

2+

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19
Q

What are the grades for pulse strength?

A

0= Absent, non-palpable
1+= Diminished pulse
2+= Normal pulse, easily palpable
3+= Bounding pulse, pulse is accentuated and very strong

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20
Q

A pt. with a Hx of diabetes and PVD has a diminished Dorsalis Pedis pulse on the R LE compared to the L LE. What pulse strength grade would you expect to be given to this patient?

A

1+

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21
Q

What is the Ankle Brachial Index (ABI)?

A

The ratio of systolic blood pressure in the LEs to the systolic blood pressure in the UEs

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22
Q

What is the formula used for a patient’s ABI?

A

Systolic pressure of LE/Systolic pressure of UE

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23
Q

What is considered a normal ABI reading?

A

.9 - 1.1

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24
Q

What is considered an undesireable ABI reading?

A

</= .7

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25
Q

How do you measure for surface arterial blood flow?

A

Squeeze and hold a fingertip or toe for 3 seconds, let go, and see how long it takes for it to refill with blood

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26
Q

What is normal Capillary Refill Time?

A

2 seconds

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27
Q

What is Rubor of Dependency used to test and how do you do it?

A

-Used to test Arterial Insufficiency (AI)
-Place pt. in supine and note color of plantar foot surface
-Raise LE to 60 degrees for one minute and not any change in color
-Lower LE back down to starting position, and if their was any change in color during LE elevation, note how long it takes the foot to return to normal color

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28
Q

What is considered Normal for Rubor of Dependency?

A

Minimal or no change in color

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29
Q

What causes a Venous Insufficiency?

A

The valves in the veins are lax and allowing backflow

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30
Q

How do you test for Venous Filling Time?

A

-Place the pt. in supine and note the superficial veins on the dorsal surface of the foot
-Elevate LE to 60 degrees for 1 minute or until blood drains from veins
-Lower LE to dependent position and note how long it takes the veins to refill with blood

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31
Q

What does it mean if a pt.s venous filling time is 5-15 seconds?

A

This is normal

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32
Q

What does it mean if a pt.s venous filling time is < 5 seconds?

A

This is indicative of a Venous Insufficiency

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33
Q

What does it mean if a pt.s venous filling time is >20 seconds?

A

This is indicative of an Arterial Insufficiency

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34
Q

What are Semmes-Weinstein Monofilaments?

A

Tools used to test the sensation of a diabetic foot

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35
Q

Should you apply lotion to the spaces between a diabetic pt.s toes?

A

No

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36
Q

What size Semmes-Weinstein monofilament should a pt. be able to feel in order to be classified as having Normal sensation?

A

4.17

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37
Q

What size Semmes-Weinstein monofilament should a pt. be able to feel in order to be classified as having Protective sensation?

A

5.07

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38
Q

What size Semmes-Weinstein monofilament should a pt. be able to feel in order to be classified as having Absent sensation?

A

6.10

39
Q

Name the surgical intervention…
-Removal of an emboli through an opening in an artery
-Balloon catheter is inserted and when removed, pulls out the emboli

A

Embolectomy

40
Q

Name the surgical intervention…
-Removal of an occlusion by stripping it and the inner lining of the artery as well

A

Endarterectomy

41
Q

Name the surgical intervention…
-Use of the saphenous vein to bypass the obstruction
-Veins are reversed so valves don’t interfere
-Common site for emboli

A

Femoral Popliteal Graft (Fem Pop)

42
Q

What percent of people with PVD will have an amputation?

A

2-5%

43
Q

What percent of people with PVD and Diabetes will have an amputation?

A

5-25%

44
Q

Which muscle re-attachment procedure for amputations involves muscle to muscle?

A

Myoplasty

45
Q

Which muscle re-attachment procedure for amputations involves muscle to bone?

A

Myodesis

46
Q

Which muscle re-attachment procedure for amputations involves tendon to bone?

A

Tendonesis

47
Q

Describe an Equal Length skin flap amputation closure

A

Skin is equal length on both sides of amputation and sutured together along the midline of the tip of the residual limb

48
Q

Describe a Long Posterior skin flap amputation closure

A

The skin on the posterior portion of the amputation is longer than the anterior portion, resulting in a suture on the anterior portion of the residual limb and an affect known as dog ears

49
Q

Describe a Skew Flap amputation closure

A

A modification made to the Long Posterior skin flap so that the flaps are skewed, therefore avoiding the dog ears affect

50
Q

What is an Ankle Disarticulation (amputation at the ankle) also known as?

A

Syme’s

51
Q

What are the key LE muscle groups to focus on strengthening Pre-amputation?

A

Hip extensors for prosthetic control, Abd/add, knee extensors for BKA

52
Q

Why is keeping the pt.s hip/knee in the extended position so important after a LE amputation?

A

-To keep from getting a flexion contracture
-To be able to effectively control their prosthetic

53
Q

What are the advantages and disadvantages of Rigid Dressing post amputation

A

-Good for edema and P! management
-Takes skill to apply
-Could end up restricting blood flow

54
Q

What are the advantages and disadvantages of Semi-Rigid Dressing post amputation?

A

-Protects wound
-Inexpensive
-Not as effective as rigid
-Could wrinkle

55
Q

What are the advantages and disadvantages of Soft Dressing post amputation?

A

-Cheapest
-Most Common
-Hard for pt. to apply themselves
-Must be reapplied frequently

56
Q

What is essential soon after amputation in order to prepare for a prosthetic?

A

Shrinking of the residual limb

57
Q

In general, how long does it take post amputation to be fitted for a prosthetic?

A

6-8 wks

58
Q

What is the Number 1 Goal for post op amputees

A

Protect the unaffected limb

59
Q

In what position does the leg of an AKA pt. tend to want to be in?

A

-Hip flexion
-Lateral rotation
-Abduction

60
Q

In what position does the leg of a BKA pt. tend to want to be in?

A

-Hip flexion
-Knee flexion

61
Q

What position do you want to try to keep an amputation pt.s residual limb in while lying in bed?

A

-In the position the pt.s leg would be in while standing
-Legs parallel, hips in neutral rotation, hips in neutral ab/ad

62
Q

How would you collect data to know that your wrapping is decreasing residual limb edema?

A

By taking girth measurements

63
Q

Which PT interventions can help to address phantom pain in amputees?

A

-IFC
-US
-Massage
-Mirrors
-Desensitization

64
Q

What do 85% of amputations start with?

A

Foot ulcers

65
Q

What is the most important piece of a prosthetic and why?

A

The Socket, because if it is not comfortable, the pt. won’t wear it

66
Q

What are the 2 most common types of suspension methods for prosthetics?

A

-Linear pin and lock
-Suction/Vaccuum

67
Q

What is the difference between Mechanical and Fluid Controlled Friction Knees in prosthetics?

A

-Mechanical knees have one speed for flexion and extension
-Fluid controlled friction knees are able to speed up and slow down flexion and extension

68
Q

What are the 2 most stable mechanical prosthetic knees?

A

-Locking knee
-Weight activated safety knee

69
Q

What are the 2 least stable mechanical prosthetic knees?

A

-Polycentric/ 4 bar knee
-Single axis/ Outside hinges

70
Q

How do Fluid controlled prosthetic knees control the speed of flexion/extension?

A

Either Pneumatic, Hydraulic, or Microprocessor systems

71
Q

What is the Shank of a prosthetic and what are the 2 kinds?

A

The component used to connect the socket/knee to the foot
-Endoskeletal (most common)
-Exoskeletal

72
Q

What does SACH foot stand for in terms of prosthetics?

A

Solid Ankle Cushion Heel

73
Q

What are Dynamic Response Feet in terms of prosthetics, who are the for, and why?

A

-They are the carbon fiber feet in the shape of a boomerang or L
-They are used for active patients who can put adequate energy into it
-Because carbon fiber acts like a spring, so you have to put energy into it to receive energy out of it

74
Q

Does a SACH foot have an articulated ankle joint?

A

No

75
Q

What are the 2 main designs of Transtibial Sockets?

A

-Patella Tendon Bearing (PTB)
-Total Surface Bearing (TSB)

76
Q

What is the thought process behind a Patella Tendon Bearing socket?

A

It loads the pressure tolerant areas (patella tendon, medial/lateral tibia, shaft of fibula, calf) and relieves pressure from intolerant areas (end of tibia/fibula, fibular head, hamstring tendons

77
Q

What is the thought process behind a Total Surface Bearing socket?

A

It creates uniform pressure for the entire limb to share equally, so that there is less pointed pressure and less perceived pressure

78
Q

Which transtibial socket design is more commonly used now?

A

The Total Surface Bearing Socket

79
Q

What are the 2 types of Transfemoral Sockets?

A

-Quadralateral Socket
-Ischial Containment Socket

80
Q

What is the difference between Quadralateral and Ischial Containment Sockets?

A

-Quadralateral sockets are square shape and maintains the ischium on top of the seat
-Ischial containment sockets are oval shape and contains the ischium withing the socket

81
Q

Is the quadralateral or ischial containment socket most common?

A

Ischial containment

82
Q

Characteristics of which TT suspension method?
-uses audible clicks to ensure prosthesis is on and fitting well
-can have issues with rotation
-in order to use, roll on liner with pin in correct orientation, use body weight to settle into distal lock

A

Pin and Lock suspension method

83
Q

Characteristics of which TT suspension method?
-requires discipline to ensure fitting correctly (can be harmful if used incorrectly)
-works to remove air from system to eliminate movement/friction

A

Suction suspension method

84
Q

Characteristics of which TT suspension method?
-most secure and intimate suspension method
-external pump is used to consistently draw air out of socket

A

Vaccuum suspension method

85
Q

What are Medicare K levels?

A

A rating system used by Medicare to indicate a person’s rehabilitation potential
-typically determines which knee and foot are appropriate for the patient

86
Q

What does Medicare K0 mean?

A

-Patient does not have ability or potential to ambulate/transfer with or without assistance
-Patient does not qualify for prosthesis

87
Q

What does Medicare K1 mean?

A

-Patient in Household ambulator
-Only uses prosthesis to ambulate on level surfaces at a fixed cadence

88
Q

What does Medicare K2 mean?

A

-Patient is a Limited Community Ambulator
-Uses prosthesis to traverse low level environmental barriers such as curbs, stairs, or uneven surfaces

89
Q

What does Medicare K3 mean?

A

-Patient is a Community Ambulator
-Uses prosthesis to traverse most environmental barriers at a variable cadence and participates in activities beyond simple locomotion

90
Q

What does Medicare K4 mean?

A

-Patient is a Child, Active Adult, or Athlete
-Uses prosthesis to exceed basic ambulation skills and exhibit high impact/stress/energy levels

91
Q

What are prosthetic socks used for?

A

-To maintain a constant fit while the limb changes in volume
-to maintain total contact fit to prevent “bottoming out” aka distal weight bearing

92
Q

Where are the TT socket pressure points the PTA should be aware of?

A

-Distal patella
-Distal tibia
-Fibular head
-Distal medial femoral condyle

93
Q

How and when should the prosthesis liner be cleaned?

A

Wash by hand on the gel side of the liner after every use?

94
Q

How and when should prosthesis socks be cleaned?

A

Machine washed and hung to dry once a week

PTA 202 (4 decks)

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