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PTH 508 Gen Med I > Exam 2 stuff > Flashcards

Exam 2 stuff Flashcards

1
Q

Capillary (Plasma) hydrostatic pressure

A
  • pressure inside vessel pushing fluid out
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2
Q

Interstitial fluid hydrostatic pressure

A
  • pressure outside vessel pushing fluid in
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3
Q

Plasma colloid osmotic pressure

A
  • pressure from proteins inside of vessel drawing fluid in
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4
Q

Interstitial fluid colloid osmotic pressure

A
  • pressure from proteins outside of vessel drawing fluid out.
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5
Q

Primary v secondary lymphedema

A

primary = developmental abnormality

secondary = acquired disorder of lymphatics

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6
Q

What is the most common cause of lymphedema worldwide?

A

lymphatic filariasis

caused by mosquitos. parasitic infection

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7
Q

most common cause of lymphedema in US?

A

procedures used for dx and treatment of cancer

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8
Q

Lymphedema: stage 0

A

latent lymphedema

- lymph transport impaired. no clinical evidence of swelling

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9
Q

Lymphedema: stage 1

A
  • reversible
  • has pitting edema
    min to no fibrosis or tissue change
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10
Q

Lymphedema: stage 2

A
  • not reversible
  • non-pitting edema
  • mod to severe fibrosis
  • may see skin changes
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11
Q

Lymphedema: stage 3

A
  • Elephantiasis
  • protein-rich edema
  • severe fibrosis
  • freq infections
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12
Q

prognosis of lymphedema

A
  • life-long, progressive condition. no cure. needs to be managed
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13
Q

distinguishing causes of edema: pitting vs non-pitting

A
  • pitting = early lymphedema, DVT, venous insuf.

- non-pitting = advanced lymphedema

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14
Q

Stemmer’s sign

A

pinch skin by toe. if you can lift skin = negative (lipedema is negative sign) if you cannot then positive for lymphedema

  • dorm of foot spared in lipedema, but involved in lymphedema
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15
Q

Lipedema

A
  • swelling due to deposits of subcutaneous adipose tissue.
  • not a disorder of the lymphatic system
  • treat swelling, address nutrition and exercise.
    • negative stemmer sign
  • ** feet uninvolved
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16
Q

Lymphedema risk reduction bolded stuff

A
  • avoid BP on affected side

- avoid overheating (hot packs)

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17
Q

What do you do if you think someone has lymphedema?

A
  • notify physician

- need script to treat for lymphedema

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18
Q

Very important to ask lymphedema pt about?

A

medical history. Cancer, surgeries, infections, etc.

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19
Q

Lymphedema severity grading. min, mod, severe

A
  • min = 40% inc
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20
Q

Complete decongestive therapy (CDT) - for lymphedema

A
  • manual lymph drainage (MLD) - massage
  • compression bandaging
  • exercise
  • skin care
  • edu, HEP
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21
Q

Low stretch bandages provide?

A

(for lymphedema)
- resistive force

  • high working pressure, low resting pressure
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22
Q

High stretch bandages provide?

A
  • compressive force

- high resting pressure, low working pressure.

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23
Q

Law of LaPlace

A

smaller the radius, higher the pressure

24
Q

Levels of compression

A

Level 1 = 20-30 mmHg
Level 2 = 30-40 mmHg
Level 3 = 40-50 mmHg
Level 4 = >60 mmHg

< 20 mmHg considered a support stocking, not for treatment.

25
Q

Exercises and lymphedema

A
  • inc lymph flow 10X

- *always performed with use of compression bandages or garments

26
Q

Other lymph tissues and organs that provide immune function

A
  • thymus, bone marrow, spleen, tonsils, peyer’s patches in small intestine
27
Q

What is the function of the lymph system?

A
  • fluid back to circulation
  • filters junk from lymph fluid
  • absorbs fats in small intestines
  • immunity
28
Q

Circulatory review.

A

Filtration = fluid leaves capillary and go to tissue

  • reabsorption = reentering circulation
  • 90% thru venous network, 10% the lymphatic
29
Q

What is the “true” cause of lymphedema

A
  • reduce lymph drainage
30
Q

What is cistern chyli?

A

lymph reservoir in abdomen at the end of the thoracic duct

31
Q

Dynamic insufficiency vs mechanical insufficiency

A

dynamic = too much fluid. no damage to system

Mechanical = true lymphedema. problem with the system. (clogged sewer)

32
Q

Does more lymph drain to right lymphatic or thoracic duct?

A
  • 1/4 to right lymphatic

- rest = thoracic duct

33
Q

Exercise dec BP by what for how long?

A

10-20 mmHg for up to 9 hours

34
Q

wt reduction to normal BMI dec BP by what?

A

5-20 mmHg

35
Q

Tunica intima

A

inner layer. smooth, prevent adherence of platelets, produces vasodilators (NO) and vasoconstrictors, semipermeable

36
Q

Tunica media

A
  • muscle

- SNS innervation

37
Q

Tunica adventitia

A

-loose connective tissue (support and protection)

38
Q

blood flow =

A

delta P/ resistance

resistance is related to length, viscosity, and 1/radius^4

39
Q

essential vs secondary HTN

A

-essential = idiopathic (90%)

secondary = identifiable cause (10%)

40
Q

what is the single most common characteristic of HTN?

A

inc TPR due to narrowing of peripheral arterioles

41
Q

what is the most important preventative factor of HTN?

A

physical activity

42
Q

FITT for HTN

A 
F = 4-7 days/wk
I = 40-60% HRR, RPE 11-13
T = 30-60 min/session
T= large muscles, aerobic activities (walking)
43
Q

a drop in what amount is considered orthostatic hypotension

A

20/10 (one or the other)

44
Q

What is an aneurysm

A

abnormal stretching or dilation of vessel wall (50% greater than normal)

45
Q

What is peripheral vascular disorders?

A

disorders or arterial and venous blood vessels. or both

46
Q

important ischemic signs and symptoms

A

numbness, coldness, pallor ****

47
Q

main risk factors for venous thrombosis

A
  • previous DVT
  • surgery/trauma
  • prolonged bed rest
48
Q

Wells clinical predictor rules

A
  • active cancer
  • immobilization of LE
  • bedridden > 3 days , major surgery last 4 wks
  • localized tenderness along distribution
  • entire LE swelling
  • unilat calf swelling >3 cm
  • unilat pitting edema
  • collateral superficial veins
  • (-2) alt dx more likely

Key: -2 to 0 = low (3%)
1 to 2 = mod (17%)
3+ = severe (75%)

49
Q

What is the goal of INR when thrombosis?

A

2.0-3.0

50
Q

which is worse? arterial or venous insufficiency

A

arterial. treat it first

51
Q

What is the gold standard for measuring edema?

A

volumetric

  • detectable change is 10 mL
52
Q

Does capillary refill test discriminated btw those with and without PAD?

A

no

53
Q

Ankle brachial index (ABI)

A

systolic of leg / systolic of arm
*should be about 1

***post exercise drop >= 25% = PAD dx
<1 arterial disease

54
Q

elevation pallor

A
  • lift leg 45-60 degrees for 60 seconds
  • normal = no change
  • testing arterial insuf.
55
Q

rumor of dependency

A
  • if pallor with elevation, quickly stand
  • normal = return in 15 sec
  • arterial issue = >30 sec and will be dark red (positive)
56
Q

venous fill time

A
  • elevate for 1 min
  • rapid change in position
  • record how long it takes to fill veins
  • too long = arterial issue
  • too quick = venous issue

PTH 508 Gen Med I (3 decks)

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