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clinical pop test 3 > Exam 3 (Lectures 7-9) > Flashcards

Exam 3 (Lectures 7-9) Flashcards

1
Q

Strengthening exercise for CF patients

A

Mode: Free weights, machines, body weight

Frequency: 3-5 days/wk

Intensity: not high for children; 50-60% 1 RM for adults, 3 sets of 12 reps (physician clearance required for adults)

Duration: For adults, 30 min of strength training with inspiratory muscle training
For children, 10 - 30 min depending on # of muscle groups

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2
Q

U.S. prevalence of CF

A

30,000 cases

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3
Q

Volume in lungs after maximum expiration

A

Residual Lung Volume (RLV)

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4
Q

Sympathetic control of the heart

A

Releases norepinephrine

Has a gradual effect

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5
Q

US prevalence of spinal cord injury

A

237,000 - 301,000 cases

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6
Q

Combining FES leg cycling and arm cycling

A

May cause pain if lower extremity sensation is preserved

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7
Q

Systemic adaptations to spinal cord injury (8)

A

1) cardiovascular
2) autonomic dysreflexia
3) pulmonary
4) bowel & bladder function
5) spasticity
6) thermoregulation
7) endocrine
8) osteopenia

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8
Q

Sympathetic neurons synapse with

A

The paravertebral ganglia

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9
Q

3rd leading cause of death in U.S.

A

COPD

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10
Q

Effects of CF on GI Tract (4)

A

1) Exocrine pancreatic insufficiency
2) CF related diabetes
3) Liver disease
4) Gallbladder disease

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11
Q

Progression of COPD (8)

A
  1. ) enlargement of bronchial mucus glands
  2. ) lung parenchyma
  3. ) less elastic recoil of lungs
  4. ) greater RLV & lung hyper-inflation
  5. ) shortened diaphragm
  6. ) loss of expiratory capacities
  7. ) dyspnea
  8. ) skeletal muscle dysfunction
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12
Q

Chronic inflammation of the bronchi

A

Bronchitis

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13
Q

20 year old spinal cord patient life expectancy

A

Tetraplegia: 40+ years
Paraplegia: 45+ years

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14
Q

< 30% FEV1 or symptoms of chronic respiratory failure

A

Very severe COPD

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15
Q

Special considerations for CF patients based on medical history and a physical exam (5)

A

1) Level of pulmonary disease
2) Peripheral factors (scoliosis, kyphosis, etc.)
3) Liver disease
4) CF related diabetes (hyper or hypoglycemia)
5) Hydration level

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16
Q

Permanent enlargement of the bronchioles and alveoli

A

Emphysema

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17
Q

Sympathetic neurons exit the spinal column at

A

T1 - T6

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18
Q

An airway obstruction causing breathing problems

A

Chronic Obstructive Pulmonary Disease (COPD)

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19
Q

Other complications of CF

A

Bone disease (20% of CF patients)

Sinusitis and/or nasal polyposis

Depression (2% in children, 25% in 35+ year olds)

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20
Q

Volume in lungs after maximum inspiration

A

Total Lung Capacity (TLC)

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21
Q

Causes of spinal cord injury

A

Alcohol (25%)

Pediatric (usually congenital like spina bifida or myelomeningocele)

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22
Q

Modern life expectancy of CF patients

A

30’s, 40’s, and beyond

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23
Q

Diagnostic value of GXT for COPD (5)

A

1) symptoms may present only with exertion
2) evaluate disease progression
3) evaluate hypoxemia during activity
4) determine need for O2 supplementation
5) evaluate response to treatment

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24
Q

Indirect lifetime cost of spinal cord injury

A

> $2.1 million/person

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25
Q

This is characterized by mucus plugging, inflammation, and an increase in smooth muscle

A

Lung parenchyma

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26
Q

CF symptoms (11)

A

1) salty tasting skin
2) wheezing or shortness of breath
3) persistent cough & excessive mucus
4) frequent lung infections
5) frequent sinus infections
6) nose growths
7) poor weight gain & growth
8) foul smelling, greasy stools
9) swollen belly
10) abdominal gas & discomfort
11) broadening of fingertips & toes

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27
Q

Absolute contraindications to SCI GXT (5)

A

1) autonomic dysreflexia
2) orthostatic hypotension
3) recent deep vein thrombosis
4) pulmonary embolism
5) pressure ulcers causing autonomic dysreflexia

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28
Q

Functional value of exercise testing in SCI

A

Design an exercise program

Return to work

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29
Q

This is used in a diffusion test

A

Carbon monoxide

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30
Q

Cost of initial hospitalization for tetraplegia

A

> $80,000 (60 days)

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31
Q

Worldwide prevalence of CF

A

70,000 cases

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32
Q

Annual number of spinal cord injuries

A

40 new cases per million people

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33
Q

Modes for SCI exercise testing

A

Arm-cycling (with Velcro straps)

Wheelchair ergometry (usually higher VO2 peaks than arm-cycling)

Customized equipment

Treadmill

Rollers

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34
Q

2 causal mechanisms of COPD

A

Oxidative stress

Inflammation

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35
Q

Shortened diaphragm = ?

A

Less force development

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36
Q

Why do we tend to avoid upper body exercise with COPD?

A

It may cause dyspnea

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37
Q

These supply blood to the spinal cord

A

Spinal arteries

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38
Q

Secondary spinal cord injury causes (6)

A

1) limits to blood supply
2) infarction of grey matter 4-8 hours after injury
3) necrosis (possible up to 1-2 levels above injury)
4) fibrous & scar tissue formation
5) obstruction of neural transmission
6) nervous system dysfunction (both somatic & autonomic)

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39
Q

Most COPD patients have both of these

A

Chronic bronchitis and emphysema

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40
Q

Components of a Pulmonary Rehabilitation program (4)

A

Assessment, education, exercise training, psychosocial interventions

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41
Q

Parasympathetic control of the heart

A

Predominates at rest
Releases acetylcholine
Has a rapid effect

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42
Q

Shortened diaphragm = ?

A

Less force development

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43
Q

Airway clearance therapies

A

Exercise

High frequency chest wall compressions (i.e.: the vest)

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44
Q

What is cystic fibrosis (CF)?

A

A genetic disorder

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45
Q

Components of pulmonary rehabilitation for CF (6)

A

1) exercise training
2) nutritional counseling
3) education on managing lung disease
4) energy-conserving techniques
5) breathing strategies
6) psychological counseling and/or group support

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46
Q

Volume in lungs after tidal expiration

A

Functional Residual Capacity (FRC)

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47
Q

Location of the alveoli

A

End of respiratory tract

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48
Q

Life expectancy of CF patients in the 1950’s

A

Few lived to attend elementary school

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49
Q

How are spinal cord injuries classified?

A

Complete vs incomplete
Level
Limbs affected

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50
Q

X-Ray of over-extended lungs and a flattened diaphragm would indicate

A

Positive diagnosis of COPD

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51
Q

Direct lifetime medical costs of complete tetraplegia

A

> $1.7 million/person

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52
Q

Role of exercise in COPD treatment

A

Aerobic training of the lower body
Resistance training in whole body
Ventilatory muscle training

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53
Q

Incomplete spinal cord injury

A

Some nervous signal can be conducted through the effected area

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54
Q

Protocol for SCI exercise testing

A

Start at 5-25 Watts
Increase power 5-10 Watts per stage
1-3 minutes per stage

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55
Q

CFTR mutation results from

A

A genetic mutation on chromosome 7

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56
Q

FES provides improvements in (8)

A

1) Muscular strength and endurance
2) Energy expenditure
3) Stroke volume
4) VO2 peak and peak power
5) Lower extremity bone mineral density
6) HDL
7) Self perception
8) Body composition

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57
Q

In 2005, there were this many deaths in COPD patients older than 25

A

126,000 deaths

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58
Q

Accommodations for exercise testing with CF

A

May have to modify to allow O2 tanks

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59
Q

CF is inherited recessively

A

1 CF gene is inherited from each parent

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60
Q

The vagus nerve is part of which system?

A

Parasympathetic nervous system

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61
Q

Comorbidities of spinal cord injury (8)

A

1) cardiovascular diseases (coronary & peripheral artery disease), which may lead to amputations
2) pressure soles
3) pulmonary problems
4) obesity (lower bmr)
5) type 2 diabetes
6) osteoporosis & osteopenia
7) shoulder overuse injuries
8) bony overgrowth in joints

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62
Q

Causes of COPD

A
  1. ) Chronic bronchitis - excessive mucus

2. ) Emphysema - loss of functional alveoli

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63
Q

Medications for CF

A

Mucolytic agents

Antibiotics for bacterial lung infections

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64
Q

Other tests for diagnosing CF (10)

A

1) Clinical examination
2) Sputum culture
3) Chest X-Ray
4) Sinus CT scan
5) Static & dynamic lung assessment (if age appropriate)
6) Blood sampling for complete cell count
7) Liver function test
8) Renal function test
9) Nutritional parameters (total protein, albumin, fat soluble vitamins, glucose)
10) Pulmonary function testing

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65
Q

How to modify existing protocols for COPD (4)

A

1) Extend stages
2) Slower progression
3) Ramping protocols
4) Smaller increments

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66
Q

Sputum producing cough

A

Bronchitis

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67
Q

Median age of death in CF patients

A

Late 30’s

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68
Q

Direct cost of cystic fibrosis

A

> $900 million/year

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69
Q

Maximum volume inspired following tidal expiration

A

Inspiratory Capacity (IC)

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70
Q

Chronic inflammation of the bronchi

A

Bronchitis

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71
Q

Exocrine pancreatic insufficiency results in

A

Malabsorption of nutrients including fats & proteins

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72
Q

The spinal cord is protected by

A

33 vertebrae

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73
Q

Flexibility training in SCI

A

Contractures

Spasticity

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74
Q

Initial hospitalization costs for paraplegia

A

> $50,000 (50 days)

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75
Q

How to diagnose spinal cord injury

A

Physical examination
X-Ray
MRI
CT Scan

76
Q

This is better at diagnosing emphysema than an X-Ray

A

CT scan

77
Q

Risk factors of COPD (5)

A

1) Smoking
2) Air pollutants
3) Genetic factors
4) Asthma
5) Respiratory infections

78
Q

Maximum volume inspired following tidal expiration

A

Inspiratory Capacity (IC)

79
Q

Diagnostic value of exercise testing for SCI

A

Coronary artery disease

Silent ischemia

80
Q

Paraplegia

A

Paralysis of two limbs

81
Q

2 ways to test pulmonary function

A

1) Spirometry

2 Pulse oximetry

82
Q

Aerobic exercise for CF

A

1) Mode: No specific optimal activity
2) Frequency: Gradual progression. 3-5 days/wk for adults. Daily for children
3) Intensity: Start low, progress gradually. Improvement stage is 70%-85% of HRmax
4) Duration: 20-60 min

83
Q

Expected power in wheelchair ergometry

A

40 - 100 Watts

84
Q

Ventilatory muscle training in COPD

A

3+ days/week
30% or more max inspiratory pressure
15+ minutes

85
Q

The ______ _______ of COPD is not fully understood.

A

Causal mechanisms

86
Q

Locomotor training

A

Improves walking ability

87
Q

Cardiovascular testing for CF

A

GXT with led exercise
Avoid upper body exercise
Exercise tolerance is predictive of survival

88
Q

Contraindications for CF exercise testing

A

No absolute contraindications
No testing during severe infections
Monitor symptoms closely

89
Q

How to prevent COPD

A

Avoid smoking and air pollutants

90
Q

The only athletes limited by lung capacity are

A

Swimmers

91
Q

Exercise training in SCI

A

Low initial intensity

Use of brakes

92
Q

Primary spinal cord injury damages (3)

A

Neural tracts
Cell bodies
Vasculature

93
Q

Complete spinal cord injury

A

No nervousness signal can be conducted through the effected level

94
Q

Diagnosis of CF

A

Sweat test (gold standard, measures chloride amount)

Genetic mutation analysis

Clinical diagnosis required ultimately (both tests can produce uncertain results)

95
Q

Medications for COPD management

A

Bronchodilators
Beta-2 agonists
Anticholinergic
Corticosteroids

96
Q

Special considerations for SCI exercise training (8)

A

1) accessibility
2) temperature control
3) abdominal binders
4) leg wraps
5) Velcro straps
6) cuffed weights
7) bladder & bowel evacuation before testing and training (catheters may be necessary)
8) possibility for silent ischemia (no angina)

97
Q

Progression of COPD (8)

A
  1. ) enlargement of bronchial mucus glands
  2. ) lung parenchyma
  3. ) less elastic recoil of lungs
  4. ) greater RLV & lung hyper-inflation
  5. ) shortened diaphragm
  6. ) loss of expiratory capacities
  7. ) dyspnea
  8. ) skeletal muscle dysfunction
98
Q

50-79% FEV1

A

Moderate COPD

99
Q

These people may become independent walkers

A

Patients with incomplete spinal cord injury

100
Q

Enlargement of the mucus secreting glands in bronchitis causes

A

Hyper-secretion of mucus clogs the alveoli.

Cough develops to remove the mucus

101
Q

Maximum inspiration at end of tidal inspiration

A

Inspiratory Reserve Volume (IRV)

102
Q

Volume of air inspired or expired per breath

A

Tidal volume (TV)

103
Q

Effects of CF on the respiratory system (3)

A

Thick mucus in the lungs obstructs the bronchial airway, bacterial infections, and inflammation.

(Progression differs between people.)

104
Q

53% of CF patients are

A

Younger than 18 years old

105
Q

Relative contraindications to SCI GXT (5)

A

1) active tendinitis
2) chronic heterotrophic ossification
3) peripheral neuropathy
4) pressure ulcers of grade 2 or less
5) spasticity

106
Q

CF related diabetes is caused by

A

Damage to the pancreas and the need to monitor blood sugar

107
Q

Number of 1995 physician visits for COPD

A

16 million

108
Q

Spirometry examines 3 variables

A

Lung volume & lung capacity
FEV1
Diffusion capacity

109
Q

Physical therapy for spinal cord injury

A

Includes physical activity and exercise

Functional electrical stimulation (FES)

110
Q

Innervation of sympathetic neurons

A

Sinoatrial and atrioventricular nodes and the ventricular muscle

111
Q

Amount of fresh air reaching alveoli

A

Alveolar ventilation

112
Q

30-49% COPD

A

Sever COPD

113
Q

This is characterized by mucus plugging, inflammation, and an increase in smooth muscle

A

Lung parenchyma

114
Q

Cause of CF

A

Mutation in gene for protein CFTR (Cystic Fibrosis Transmembrane Conductance Regulator)

Both copies of CFTR or mutated

115
Q

Cost of COPD in 2000

A

$24 billion

116
Q

Number of people in U.S. with COPD

A

30 million

16 million diagnosed
14 million undiagnosed

117
Q

Origin of the vagus nerve

A

Medulla obloganta

118
Q

People with this condition have a decreased ability to perform expiration

A

Emphysema

119
Q

Measures for CF exercise testing (3)

A

1) Ventilation
2) ECG
3) Pulse oximetry (if < 90% possibility for supplemental O2 for training)

120
Q

Progression of emphysema (3)

A
  1. ) destruction of elastin in alveolar walls
  2. ) alveoli unable to hold functional shape upon exhalation
  3. ) prolonged exhalation
121
Q

COPD exercise mode

A

Walking or leg cycling

122
Q

Functional value of GXT for COPD (2)

A

1) low functional capacity due to pulmonary limitations

2) development of exercise programs

123
Q

The most common life shortening genetic disease in Caucasians

A

Cystic fibrosis

124
Q

Supplement to diet for CF

A

Pancreatic enzymes

Fat soluble vitamins

125
Q

Effects of exercise in COPD treatment

A

Less dyspnea

Higher exercise capacity

126
Q

Must last this long to be classified as bronchitis

A

3 months in 2 consecutive years

127
Q

COPD diagnosed how

A

Spirometry, chest X-Ray, and CT scan

128
Q

In COPD, the bronchial mucus glands ______.

A

Enlarge

129
Q

Flexibility exercise for CF

A

Static training for major muscle groups

Frequency: 2+ days/wk
Before & after aerobic & anaerobic activity
Include with every exercise program

Intensity: Gentle pull in muscle, don’t force stretches

Duration: 10-30 sec/stretch

130
Q

Cost per person for CF

A

$40,000 per year

131
Q

Body composition for CF

A

Monitor height, weight, & BMI against growth charts

132
Q

Expected response to SCI exercise testing

A

Low VO2 peak

HR peak of 120 bpm in complete tetraplegia and T1-T3 paraplegia.

HR peak is normal below T7.

133
Q

Maximum volume expired after maximum inspiration

A

Forced Vital Capacity (FVC)

134
Q

Maximum expiration at end of tidal expiration

A

Expiratory Reserve Volume (ERV)

135
Q

Occupational therapy for spinal cord injury (5)

A

1) strengthen muscles & improve function
2) self care
3) transfer & mobility skills
4) domestic and work environment modifications
5) domestic & community living skills

136
Q

Goals of exercise program for CF management (6)

A

1) Improve physical fitness and ADL
2) Improve quality of life
3) Reduce symptoms
4) Alleviate associated & secondary conditions
5) Ensure enjoyable participation
6) Ensure safety

137
Q

Sputum producing cough

A

Bronchitis

138
Q

Measured in breaths/minute

A

Minute ventilation

139
Q

Locomotor training should focus on

A

Unweighted walking with manual or mechanical exercise

140
Q

Cost of COPD per hospitalization

A

$10,684

141
Q

Abnormal CFTR results in

A

Abnormal sodium chloride & water movement across the cell membrane

Abnormally thick and dry mucus

142
Q

Origin of sympathetic neurons

A

Medulla

143
Q

Secondary spinal cord injury is caused by

A

Hemorrhage and edema within the spinal cord

144
Q

Exercise training for SCI involves a multidisciplinary team

A

Exercise physiologist
Physical therapist
Physician

All help with goal setting

145
Q

Goals of pulmonary rehabilitation (5)

A

1) Decrease airflow limitations
2) Decrease respiratory symptoms
3) Improve exercise capacity
4) Promote independence
5) Improve quality of life

146
Q

Considerations for CF exercise program (5)

A

1) Start after determining dyspnea level & supplemental O2 need
2) Adjust volume by severity
3) Make physical activity fun for children

147
Q

Functional electrical stimulation provides

A

Electrical stimulation for movement in paralyzed limbs

148
Q

greater than or equal to 80% FEV1

A

Mild COPD

149
Q

Bronchitis causes the mucus secreting glands to

A

Enlarge

150
Q

Volume in lungs after tidal expiration

A

Functional Residual Capacity (FRC)

151
Q

2 causal mechanisms of COPD

A

Oxidative stress

Inflammation

152
Q

Aerobic training in COPD

A

3-5 days/week
20-60 minutes if continuous or intermittent activity depending on COPD severity
Walking or stationary cycling
Follow older adults recommendations

153
Q

Symptoms of COPD (6)

A
  1. ) Coughing
  2. ) Wheezing
  3. ) Dyspnea
  4. ) Fever
  5. ) Low tolerance for exercise and physical activity
  6. ) 20-30% lower strength
154
Q

HR response in SCI exercise training

A

Above T7: lower submax HR and lower sympathetic activation

T7 or below: higher submax HR

155
Q

Number of COPD cases in 2000

A

726,000 cases

156
Q

Components of ventilatory muscle training (3)

A

1) voluntary isocapnic hyperpnea
2) inspiratory resistive loading
3) inspiratory threshold loading

157
Q

This variable is not valid in advanced CF patients

A

Predicted HRmax

158
Q

Value of GXT concerning COPD (3)

A

Diagnostic, prognostic, & functional

159
Q

Characteristics of CF

A

Obstruction of passageways of the bronchi, intestines, & pancreas & bile ducts by excessively viscid mucus

Increased sodium and chloride in sweat

160
Q

This may cause 20-30% lower strength in COPD

A

Chronic steroids use which causes myopathy or muscle wasting

161
Q

Treatment for CF (7)

A

1) Medication
2) Daily mucus clearance techniques
3) Airway clearance therapy
4) Fat-soluble diet
5) High-fat, high calorie diet
6) Pulmonary rehabilitation
7) Supplements

162
Q

Tetraplegia

A

Paralysis of four limbs

163
Q

Standard exercise termination criteria for COPD patients

A

Relative: shortness of breath, wheezing, etc.

Also, severe arterial de-saturation of <80%

164
Q

Traps air in lungs and chronically causes anatomical alterations

A

Emphysema

165
Q

Spinal cord injuries affect

A

The conduction of neural signals

166
Q

Resistance training in COPD

A

Improving upper body strength to reduce dyspnea

167
Q

Multi-factorial COPD management (4)

A

1) Smoking cessation to reduce FEV1 decline.
2) Medication
3) Supplemental O2 therapy
4) Pulmonary rehabilitation for symptomatic COPD patients

168
Q

Strength training in SCI

A

Focus on scapular stabilization

Risk of overuse

169
Q

How many new CF cases per year in the U.S.

A

1000 new cases

170
Q

Management of spinal cord injury

A

Medication (short & long term)
Surgery
Physical therapy
Occupational therapy

171
Q

In COPD, a low tolerance for physical activity in conjunction with hypoxemia will cause (4)

A
  1. ) loss of muscle mass
  2. ) less oxidative enzymes
  3. ) alterations in muscle fiber types (less Type I, more Type II B)
  4. ) 20-30% lower strength
172
Q

Treatment for bronchitis (2)

A

Anti-biotics

Bronchodilators

173
Q

Cardiovascular adaptations to spinal cord injury

A

Loss of vasomotor tone
Venous pooling
Orthostatic hypertension

174
Q

In COPD, the bronchial mucus glands ______.

A

Enlarge

175
Q

5 results of nutrient malabsorption in CF

A

1) Steatorrhea (oily, smelly stools)
2) Malodorous stool
3) Abdominal pain
4) Malnutrition
5) Constant struggle to maintain body weight

176
Q

Collagen and elastic fibers contribute to

A

Stretching and recoil of alveolus sac

177
Q

The ______ _______ of COPD is not fully understood.

A

Causal mechanisms

178
Q

Goal of pulmonary testing

A

To examine the patient’s response to exercise.

179
Q

CF affects these systems (3)

A

Respiratory, digestive, and reproductive systems

180
Q

exercise testing with functional electrical stimulation (FES)

A

Higher venous return
Higher stroke volume
Higher VO2 peak

181
Q

Must last this long to be classified as bronchitis

A

3 months in 2 consecutive years

182
Q

Number of alveolus

A

300 million

183
Q

FES provides improvements in (8)

A

1) Muscular strength and endurance
2) Energy expenditure
3) Stroke volume
4) VO2 peak and peak power
5) Lower extremity bone mineral density
6) HDL
7) Self perception
8) Body composition

184
Q

If the spinal injury is complete at or above C4

A

No use of arms

Exercise with FES

185
Q

Functional electrical stimulation provides

A

Electrical stimulation for movement in paralyzed limbs

186
Q

Innervation of vagus nerve

A

Sinoatrial and atrioventricular nodes

187
Q

What does supplemental O2 therapy do?

A

Prevents tissue hypoxia

Achieves 90% O2 saturation

clinical pop test 3 (1 decks)

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