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Pathology > Final > Flashcards

Final Flashcards

1
Q

UTI - Risk Factors

A

Age

Immobility

Instrumentation and urinary catheterization

Atonic bladder (spinal cord)

Increased sexual activity

Spermicide associated in use with diaphragm

Uncircumcised penis

Obstruction (Renal calculi, Prostatic Hyperplasia, Malformations or urinary tract abnormalities)

Constipation

Women is greater than men (Anatomic variations, Surgical or natural menopause without hormone replacement therapy, Pregnancy)

Kidney transplantation

Diabetes Mellitus

Partners of Viagra

STDs

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2
Q

UTI - Pathogenesis

A

Most common route: Urethra -> Bladder

Upper or Lower Urinary Tract Infection

Blood borne

Fecal associated gram negative (E. coli – 80%, Staphylococcus – 5-15%)

Acquired via lymphatic system

Prevention: Intermittent/condom catheter

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3
Q

Urinary Incontinence - Definition

A

loss of bladder control or being unable to control urination

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4
Q

Stress Incontinence

A

Physical exertion-bending, sneezing, coughing ->

Increase intrabdominal pressure ->

Weakness of PFM (external urethral sphincter) and failure of internal urethral sphincter (IUS)

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5
Q

Urge Incontinence (Overactive incontinence)

A

Sudden desire

Detrusor instability – not fully understood

Triggers: Running water, anxiety, arrival at home

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6
Q

At what age does incontinence typically occur?

A

> 60 years

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7
Q

Normal characteristics of urine

A

Color: Yellow-Amber

Urochome – waste product during protein metabolism

Voiding: 3-5 hours and in elderly 2 hours

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8
Q

Abnormal characteristics of urine

A

Negative: Glucose, Ketones, Blood, Protein, Bilirubin, RBC, WBC

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9
Q

Pyelonephritis

A

Bacteria ascending from bladder to kidney

Cause: Vesicoureteral reflux (Backflow of urine into the kidneys)

Clinical Manifestations: Abrupt, Murphy’s Sign (punch costal-vertebral angle)

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10
Q

Renal Cell Carinoma

A

Tumor in kidneys

Palpable abdominal mass

Hematuria – 50%

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11
Q

Wilms Tumor (nephroblastoma)

A

Most common in children

Malignant

Clinical manifestations: abdominal mass

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12
Q

Renal Calculi - Nephrolithiasis

A

Acute “Colicky” pain – flank pain radiates to groin or perineal area (scrotum in males and labia in female) with hematuria

Severe pain – no comfortable position

(stones)

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13
Q

Renal Cystic Diseases

A

Cyst with fluid or tubular elements (semi solid) ->

Degeneration of renal tissue ->

Obstruction of urine flow

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14
Q

Polycystic Kidney Disease (PKD)

A

Significantly enlarged kidneys (palpable abdominal mass)

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15
Q

What is Chronic Kidney Disease?

A

Progressive loss -> End Stage Renal Disease (ESRD) -> Require dialysis or transplant

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16
Q

CKD - Pathogenesis

A

Release of angiotensin leads to VC

Reduce surface area for filtration -> Reduced Glomerular Filtration Rate (GFR)

Afferent, filtration system , bowman space, proximal tubule, into distal convulant tubule leads to excretion.

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17
Q

CKD - Stages w/values

A

G1: Normal GFR** (> or = 90mL/min) but other signs and symptoms indicating kidney disease **

G2: Kidney damage with midly decreased GFR (60-89 mL/min)

G3a: Mildly to Moderately decreased GFR (45-59 mL.min)

G3b: Moderately to Severely decreased GFR (30-44 mL/min)

G4: Severely decreased (15-29 mL/min) **Systemic damage **

G5: Kidney failure (ESRD, GFR ,15 mL/min) Systemic damage

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18
Q

Stage G1

A

Blood Urea Nitrogen (BUN) and Creatinine – typically normal

Stage 1 – reversible (DM), remain indefinitely, some progress

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19
Q

BUN and Creatinine

A

If kidney is damaged -> Urea retention is high in blood (BUN)

Creatine provides energy to muscles and forms Creatinine (byproduct)

Creatinine travels in blood and excreted in urine

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20
Q

Stage G2

A

Damage capillaries – leak albumin in urine

Can remain here if proper control of HTN and blood glucose

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21
Q

Stage G3a-b:

A

More noticeable albumin in urine than blood -> Azotemia

Azotemia: increased BUN and Creatinine (Fever, nausea, etc.)

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22
Q

Stage G4

A

Kidney not able to function

Proteinuria (albuminuria): Excess amounts of urine

Increased BUN and Creatinine

Increased renin -> hypertensive -> progress to stage 5
(Renin being made causes VC leads to HTN)

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23
Q

Stage G5

A

Failed kidney often needs multiple dialysis and transplant

Uremia – nausea, vomiting, anorexia, lethargy, pruritis (itching), sensory/motor neuropathy, pericarditis, impaired heart function, asterixis, seizures

Kidney cannot excrete toxins

Not able to maintain pH, fluid, electrolyte

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24
Q

Implications of PT - Kidney Disease

A

Aware of early signs and symptoms

Always ask: Hematuria, unexplained weight loss

Constitutional Symptoms (aka red flags)

Unexplained or insidious onset of back pain, flank or shoulder pain

New onset of mental state changes or increased confusion – delirum or confusion

Appropriate catheter care – obubstructed flow
(Do not hang the urine collection bag above the level of the bladder, never allow kinking, do not rest it on the floor)

Sternal pain or mass – most common due to metastasis to sternum

HTN – due to obstruction (VC increased leads to this)

Risk for UTI

Increased risk for cerebral and aortic aneurysm (weakening of blood vessels)

Risk for mitral valve problems (more fluid in blood leads to more strain)

Intermittent and sometimes not severe colicky pain

Unilateral back pain – thoracolumbar junction to illiac crest

Murphy’s sign (palpation)
- Treat or refer?
–Refer but screen for more information

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25
Q

Implications of PT - Chronic Kidney Disease

A

Analgesic Nephropathy (toxicity due to chronic NSAIDs)

HTN Meds (Angioedema is swelling of face, mouth, or throat; educate your patients to slowly rise, dangling feet and legs before standing, educate to report unusual swelling)

Short Term Memory Deficits

Osteoporosis Education (Avoid bending and twisting)

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26
Q

Implications of PT - Dialysis

A

Do not measure BP on the access site

Watch for HTN and Depression

Hand hygiene is most important – contact transmission (WBCs are being urinated our due to condition so infection risk is high)

Loss of lean body mass masked by fluid retention and weight gain (lose all protein in muscles)

Dialysis hypotension is common – drop in SBP >20 mm Hg or a decrease in Mean Arterial Pressure by 10 mm Hg

Ischemia of the limb: due to Thrombus formation in the access site

Itching and HS reactions

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27
Q

Exercise Considerations - CKD

A

Mild to moderate strength and mobility training – longer duration needed (slowly increase intensity)

3x/week at 40-70% of target HR

Before, during, after dialysis exercise is fine (watch for signs and symptoms)

Dialysis and non-dialysis days are fine

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28
Q

Exercise Considerations - ESRD (End Stage Renal Disease)

A

Use RPE to monitor Exercise

Exercise 4-6x/week, interval training

No exercise if K (potassium) is >5 mEq/L

BP >200/100 mm Hg – No exercise

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29
Q

Implications of PT - Urinary Incontinence

A

Bladder Training – Diary and Voiding Schedule

Hypotension precautions – slow rise from the bed

Pelvic Floor Muscle Exercises and Electrical Stimulation
-10 reps, 3-5x a day
-Vaginal Cone
-Biofeedback for relaxation

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30
Q

GI Disorders - Signs & Symptoms

A
  • Nausea and Vomiting
  • Diarrhea
  • Anorexia
  • Constipation
  • Dysphagia
  • Achalasia (difficulty passing food)
  • Heartburn
  • Abdominal pain
  • GI bleeding (Hematemesis, Melena, Hematochezia)
  • Fecal (Incontinence)

Allways look for Constitutional Symptoms (Red Flags)

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31
Q

Causes of intrabdominal pressure

A

Lifting
Straining
Bending over
Prolonged sitting or standing
Chronic or forceful cough
Pregnancy
Ascites
Obesity
Congestive Heart Failure
Low-Fiber Diet
Constipation
Delayed bowel movement
Vigorous exercise

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32
Q

Hernia - Pathogenesis

A

Increased abdominal pressure + enlarged cardiac sphincter, pushes stomach through diaphram

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33
Q

Hernia - Clinical Manifestations

A

Inguinal Hernia
- Intraabdominal pressure can lead to this

Sliding Hernia
- Heartburn in 30-60 minutes after meal

Large Sliding hernia
- Substernal pain

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34
Q

Hernia - PT Implications

A

Avoid flat supine position and exercise that requires valsalva maneuver

Educate about intraabdominal pressure (Flex: Breath in; Extend: Breath out

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35
Q

GERD (Gastroesophageal Reflux Disease) - Pathogenesis

A

Reflux (backward flow) of gastric contents into the esophagus due to relaxation of lower esophageal sphincter or alteration in esophageal acid clearance

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36
Q

GERD - Complications

A

Esophagitis -> Erosions and Ulcer -> Scarring -> Narrowing of esophagus (difficulty swallowing)

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37
Q

GERD - Signs & Symptoms

A

Heartburn – burning sensation from stomach and rising to chest

30 to 60 minutes after large meal or spice foods, meal with alcohol

Radiate to throat, back and chest

Nighttime is common – lying down

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38
Q

GERD - PT Implications

A

Promote
-Weight loss (overweight -> excess abdominal fat -> pressure on stomach)
-Swimming and biking than agitative activities (running and aerobics)

Avoid
-Strenuous exercise – inhibits gastric and small intestinal emptying
-High calorie and fatty food immediately before exercise

Positioning
-More upright position
-Esophageal sphincter strengthening
-Left side lying (prevent regurgitation, aspiration, and promote oropharyngeal accumulations)

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39
Q

Gastritis

A

Disorder to the mucosa (not muscularis mucosa)

Acute: Hemorrhagic or erosive (NSAIDS and Asprin)

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40
Q

Gastritis - Signs & Symptoms

A

Epigastric pain with abdominal distension, heartburn, Occult GI bleeding

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41
Q

Peptic Ulcer - Patho

A

Erosion or ulcer of stomach or duodenum due to mucosal insult

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42
Q

Peptic Ulcer - Signs & Symptoms

A

-Epigastric pain – burning, cramping, aching near xiphoid
-Radiates to back, midthoracic back, upper quadrant, right shoulder
-Perforation of stomach or duodenum
- Coffee-ground emesis (vomiting blood), melena (dark, tarry stools)
- Back pain relieved by antacids –GI and refer

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43
Q

Celiac Disease (Dermatitis) - Patho

A

Exposure to gluten -> T-cells on intestine (hypersensitive) -> Inflammation and destruction of intestinal cells -> Complications – Cancer, osteoporosis, etc.

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44
Q

Dermatitis - Clinical Manifestations

A

No symptoms to life threatening (late diagnosis)

GI symptoms

Nutritional deficits – folate, iron, Vit B12, fat-soluble vitamins

Skin: Dermatitis Herpetiformis – rash with intense itch

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45
Q

What is this?

A

Dermatitis Herpetiformis

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46
Q

Inflammatory Bowel Disease (IBD) - Two types:

A
  • Crohn’s Disease
  • Ulcerative Colitis
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47
Q

Crohn’s Disease

A

Chronic, lifelong, inflammatory diorder- any segment of the intestine can affect all layers of intestines.

Skip lesions – diseased areas of intestine with normal intestines between

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48
Q

Ulcerative Colitis

A

Chronic inflammatory disorder of the mucosa of the colon – typically rectum -> proximal involvement to entire colon

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49
Q

IBD - Clincial Manifestations

A

Joint problems – Sacroilitis, monoarthritic, polyarthritic. Migratoey arthralgia (first manifests (sometimes before bowel symptoms)

Ileum – periumbilical pain, lower right quadrant, can refer low back

Psoas abscess – due to extension of intraabdominal infections
- Flexion deformity with pain in extension, fever, lower abdominal pain buttock, hip, thigh, knee; antalgic gait.
- Muscle Tests (Obturator and Iliopsoas (can also do palpation))

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50
Q

Dehydration - Symptoms

A

Dry lips, hands

Headache

Brittle hair

Incoordination

Disorientation

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51
Q

Irritable Bowel Syndrome

A

Chronically recurring abdominal pain or discomfort associated with altered bowel habits – no structural, inflammatory, or biochemical abnormalities

**Unknown cause **

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52
Q

IBS - Clincial Manifestations

A

Pain – steady or intermittent, morning or after eating

Typical: lower left quadrant pain and constipation and/or diarrhea

Often: Relief with evacuation

Tend to disappear during sleep – Nocturnal GI symptoms suggests other GI disorder

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53
Q

Diverticulitis

A

Fecal matter goes inside and causes inflammation in intestines

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54
Q

Diverticulitis - Clinical Manifestations

A

Diverticulosis: Asymptomatic: mild, nonspecific, episodic pain

Diverticulitis: 75% uncomplicated. Left quadrant episodic or constant abdominal pain (often left side – sigmoid)

10-15% - urinary symptoms (bladder)

Eating and increased abdominal pressure can increase pain. Bowel movement or passage of flatus – temporary or complete relief.

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55
Q

Diverticulitis - When to refer?

A

Back pain of non- traumatic or unknown origin – referral if needed

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56
Q

Colorectal Cancer - Signs and Symptoms

A

Cardinal Sign: Bright Red Stool (rectum)

Diverticulosis, anal fissures, and hemorrhoids

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57
Q

Appendicitis - Clincial Manifestations

A

Acute appendicitis: Sequential abdominal pain (epigastric, periumbilical or right lowe quadrant)

Constant Right lower quadrant pain/tenderness

Older adults – slight increase in temperature, vague and mild pain, confusion

Women – Acute pelvic pain

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58
Q

Appendicitis - PT Implications

A

Early recongition is critical

Typical presentation: right thigh pain, groin (testicular), pelvic pain, referred to hip

Pinch an inch test -> Positive if it reproduces right lower quadrant pain

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59
Q

Peritonitis - PT Considerations

A

Mostly hospitilized

Monitor vitals

Semi-Fowler position (head an torso raised between 15-45 degrees

Raise the side rails

Extreme caution during positional changes – severe pain – report to team

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60
Q

Hepatitis

A

Inflammation of the liver

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61
Q

Hepatitis A

A

Virus (acute infectious condition)

Infection route: Fecal-oral, contaminated food or water, person-person contact

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62
Q

Hepatitis B

A
  • Serum Hepatitis
  • Blood, body fluids/tissues, oral or sexual contact
  • Can lead to cancer
  • Second major cause of cirrhosis
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63
Q

Hepatitis C

A

Same as Hep B Virus!

Blood, body fluids/tissues, oral or sexual contact

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64
Q

Liver Disease - Signs and Symptoms

A
  • Jaundice
  • Asterixis
  • Dark Urine
  • Spider angiomas (branched dialations of supericial capillaries)
  • Pain: Right shoulder pain
  • Right Upper Quadrant Pain
  • GI symptoms
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65
Q

Jaundice

A

Aka Icterus
Overproduction of bilirubin

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66
Q

Asterixis

A

Flapping tremor or liver flap and numbness (misinterpreted for carpal tunnel syndrome)

Inability to maintain wrist extension with forward extension of the upper extremity – quick, irregular flexion and extension of the wrist

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67
Q

Cirrhosis - S & S

A

Ascites

Bleeding gums

Frequent and heavy nose bleeds

Hematemesis

Light stools (almost white) and Tarry stools

Change in dress – shoes unlaced or wear slippers?
- Edema – bilateral feet and ankles

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68
Q

Gall bladder - Clinical Manifestations

A

RUQ pain with radiation to right scapula (below or between scapula)

Worsen with fatty meal

Murphy’s sign: Pain – subcostal margin palpation as patient inhales

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69
Q

Acute Pancreatitis - Signs & Symptoms

A

Mild to profound pain with systemic effects

Abdominal pain – RUQ (dull to maximum intensity within 10-20 minutes)

Back pain

Pain after meal. No comfort with positional change

Trigger: High fat meals

Severe: Tachycardia, Tacypnea, hypoxia, pancreatic fluid filled collection

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70
Q

Pancreatitis - Patho

A

Chronic Pancreatitis

Chronic inflammation -> irreversible changes

Cause: Alcohol (>50% of cases) metabolite acts as a toxin

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71
Q

Pacreatitis - Clinical Manifestations

A

Epigastric pain – radiates to back

Pain worsens with meal but relieved knee to chest or forward bending

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72
Q

Pancreatitis - PT Implications

A

Preferred position for both acute and chronit pancreatitis - leaning forward, sitting up, knee to chest position in side lying
Even small ice chips can increase pain - Do not give any food unless nurse/physician allows. Document

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73
Q

Thrombogenesis

A

Formaiton of blood clots

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74
Q

Types of thrombus

A

Arterial – Platelet rich (MI, CVA, PAD) -> amputation -> death

Venous – RBCs and Fibrin (Ex: SVT, DVT

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75
Q

Embolus

A

A solid mass, gas, liquid, fat moves within blood vessel and lodges at a distant site

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76
Q

Prothrombin Time (PT)

A

Measures how fast blood can clot

Normal: Range 11 to 13.5 seconds

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77
Q

Partial Thromboplastin (PTT)

A

Monitor patient response to anticoagulants

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78
Q

D-dimer

A

Dissolution of Clot -> Fibrin threads (D-dimer)

(>500 ng/mL) -> moderate to high risk (DVT)

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79
Q

Wells Clincial Prediction Rule

A

-2 to 0: Low probability

1-2: Moderate

> or = 3: High

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80
Q

Hemorrhage - Def

A

Blood escaping from a ruptured blood vessel

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81
Q

What is this?

A

subdural hematoma

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82
Q

What is this?

A

Ecchymosis

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83
Q

What are these two called?

A

Purpura (Right) and Petechiae (Left – small)

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84
Q

Edema - Def

A

Accumulation of fluid within interstitial tissues or within body cavities

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85
Q

What is this called?

A

Anasarca

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86
Q

Anasarca - Def

A

Generalized Swelling

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87
Q

Common causes - Anasarca

A

Liver failure

Kidney failure

Right sided heart failure

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88
Q

Anasarca - mechanism

A
  • Hydrostatic force – water pushes it out
  • oncotic – protein, increases pressure
  • No protein, no oncosing pressure to push stuff back
  • Ex: Liver
  • Produces no protein -> We have water outside, no proteins -> Pitting
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89
Q

Pitting

A

Often associated with non-lymphatic obstruction

Low protein, high water. Easier to treat.

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90
Q

Non-Pitting

A

Often with chronic lymphatic obstruction

Harder to treat. High protein.

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91
Q

Types of shock

A

Hypovolemic: loss of more than a fifth of blood plasma leading to reduced tissue perforation. Insufficient amount of blood for the heart to pump leads to organ failure.

Cardiogenic: Unable to properly pump oxygen rich blood around

Reduced system vascular resistance

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92
Q

Shock - Signs & Symptoms

A

Tachycardia

Tachypnea (shallow/narrow breaths)

Cool extremities

Decreased pulses

Decreased urine output

Altered mental status

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93
Q

Atherosclerosis

A

Plaque (a fatty mass protruded in the blood vessel lumen)

Beginning: simple and reversible (Exercise and diet)

Later: Endothelial cells swollen with accumulation of lipids and develop gaps between endothelial cells

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94
Q

Atherosclerosis - Modifiable RF

A

**Shown to reduce:

Smoking – Nicotine (increases fibrinogen and produces some chemicals that directly affect BV)

Elevated LDL/Total Serum Cholesterol

HTN

Likely reduce

Obesity

Physical Activity is equal to high cholesterol, smoking and high BP

Diabetes (Target A1C <6.5%

Low HDL

60% of adults in the US lead a sedentary life compared to HTN (10%), hypercholesterolemia (10%), smoke one or more packs a day (18%)**

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95
Q

Atherosclerosis - Non-modifiable RF

A

Age (Women >55; Men >45), Gender (male), Genetics, Ethnicity, Infection (viral, bacterial)

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96
Q

ABI - Normal/Abnormal

A

Normal: 1.0-1.4

Abnormal: Less than or equal to 0.8. No support stocking! Artery is constricted already, do not want to cause more vasoconstriction.

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97
Q

BP Guidelines

A
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98
Q

Orthostatic Hypotension - Patho

A

Autonomic nervous dysfunction (Smooth Muscle – heart and BV – heart-beat, widening BV)

Can cause hypotension: L-dopa, Nitrates, Calcium channel blockers

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99
Q

Hypotension - Signs & Symptoms

A

Dizziness

Blurring or loss of vision

Syncope or fainting

In older adults: Unexplained or unexpected falls, acute or chronic mental confusion, cardiac symptoms

Lethargy, weakness

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100
Q

HTN - Signs & Symptoms

A

Asymptomatic: Elevated BP is only sign in early stages

Headache (worse in morning – cortisol, worse on walking)

Vertigo

Flushed face

Spontaneous epistaxis (nosebleed)

Blurred Vision

Nocturnal urinary frequency

Progressive HTN
- CV Symptoms: Dyspnea, orthopnea, chest pain, leg edema
- Cerebral symptoms - confusion

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101
Q

Aneurysm - Patho

A
  1. Loss of smooth muscle cells
  2. Increased matrix metalloproteinase – degradation of elastin

Plague -> Erode -> Stretching of inner/outer layer -> Sac formation

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102
Q

Aneurysm - Def

A

Abnormal stretching (dilation) of blood vessels (typically > or = 50% of the diameter) - arteries and veins

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103
Q

Abdominal aneurysm

A

4x more common

Mostly asymptomatic

Intermittent or constant pain

**Mild to severe mid-abdominal

Groin, genitalia, buttock, legs or flank pain

Abdominal heartbeat or dull ache – supine

Back pain may be the only symptom before rupture

> or = 5 cm -> rupture**

104
Q

Abdominal aneurysm - S & S

A

Sudden Severe Headache

Nausea and vomiting

Pain above and behind one eye

Sensitivity to light

Drooping eye lid

105
Q

abdominal Aneurysm - PT Implications

A

Single or bilateral SLR (single leg raise) - manual muscle testing precautions

Only one leg at a time!

Always palpation for mass before any abdominal procedures – manual therapy or soft tissue/scar mobilization

106
Q

DVT - RF

A

Hospitalization/Immobilization

Cardiac Failure

Surgery

Fracture or dislocation

Local trauma

Smoking

Genetics

Neoplasm

Diabetes Mellitus

Obesity

Previous DVT

> 60 years old

107
Q

DVT - S & S

A

Dull ache or tight feeling in legs

Pain or tenderness in calf

Leg or calf swelling
- Pitting edema

Warmer skin

Dilation of superficial veins

Cyanotic – severe obstruction

108
Q

DVT - Precautions

A

Compression and anticoagulation are standard

Anticoagulant therapy - Monitor for blood in urine, stool, teeth, or any bleeding

109
Q

DVT - Ambulation

A

Warfain (Brand name: Coumadin) - Monitored by PT reported as INR

Do not ambulate until you receive results

Un-fractioned Heparin – monitored by PTT

Ambulate if normal

Low molecular weight heparin (LMWH) - almost immediately

110
Q

What is this?

A

Varicose Veins

111
Q

Varicose Veins - S & S

A

Dialted, tortuous, elongated veins beneath skin upon standing

112
Q

Varicose Veins - PT Implications

A

Education
- Avoid – prolonged standing, sitting, corssing legs, sitting too high or deep, constrictive clothing

Compression – Gold standard

Do ABI before compression
- Want to make sure it is venous NOT arterial. We don’t want to compress BVs if it is arterials because we don’t want vasoconstriction.

113
Q

Chronic Venous Insufficency - S & S

A

Hemosiderin – stores iron in tissues

Venous stasis ulcer (80% of ulcers)

Can be very painful

114
Q

Pulmonary Embolism - Clincial Manifestations

A

**Can lead to silent death

Depends on size and location:

Pleuritic chest pain – inhalation and exhalation

Hemoptysis (cough up blood)**

115
Q

Angina - Pathogenesis

A

Myocardial oxygen supply DOES NOT meet an increase in Myocardial Oxygen Demand.

Heart is supplied with blood from the coronary arteries. Without oxygen leads to chest pain.

Causes: Artherosclerosis, Aneurysm, Cocaine use (Sympathomimetic effect, increases HR and contractility), >90% cases caused by Coronary artery occlusion (one or more coronary artery) - Metabolites in the ischemic cell or stretching of myocardium -> irritates myocardial fibers -> myocardial pain

116
Q

Angina - Types

A
  • Stable Angina
  • Unstable Angina
117
Q

Stable Angina

A

Classic Exertional Angina

Symptoms relieved with rest or with Nitroglycerin (<15 minutes)

Predictable using Rate Pressure Product (RPP = HR x SBP)

Measures stress on cardiac muscle

118
Q

Unstable Angina

A

Unpredictable symptoms and can occur at any time without any precipitating factors

Usually lasts >15 minutes

Resistant to treatment (Nitroglycerin doesn’t have an effect)

Increased risk for MI and Heart arrythmias (lethal)

119
Q

Angina - Signs and Symptoms

A

Shortness of breath

Fatigue

Diaphoresis (increased fatigue)

Weakness

Women: Discomfort, crushing and pressing, bad ache

Atypical: Older Adults
Dyspnea
Diaphoresis (Increased fatigue)
Nausea
Vomiting
Syncope

Substernal Pain or retrosternal pain

MI

Fingers clenched, middle of chest, substernal pain

120
Q

Angina - PT Implications

A

Differential Diagnosis
- Anterior chest wall syndrome: localized tenderness of intercostal muscles
- Tietze syndrome: costochondral junction inflammation
- Heartburn: Indigestion, Hiatal hernia, gallbladder, esophageal spasm, peptic ulcer, stress
- Pectoralis Major/Minor Tightness

121
Q

Nitroglycerin

A

Keep handy

Not relieved by rest or not relieved up to three doses of NG in 10 to 15 mins (5 minutes incremental) – Needs physician evaluation

Promote sitting during Nitroglycerin administration – Syncope & Falls

Check expiration if NG does not produce a burning sensation under the tongue – Need to be replaced in 3 months

Educate patients to follow Nitroglycerin schedule (not less or not more)

Monitor Vitals (BP, HR, and RR)

122
Q

What is the leading cause of death in the Unites States?

A

Myocardial Infarction

123
Q

What is the best predictor of heart attack and CHF?

A

Best predictor of Heart Attacks (MI)
- Waist to Hip Ratio

Best predictor of CHF
- Pulse Pressure
40 = Healthy
>40 = Abnormal

124
Q

Zones of infarction - MI

A

Non-contractile tissue, electrically inert

Dead cells removed and fibrous scar formation

125
Q

Transmural MI

A

Necrosis of entire heart tissue

126
Q

Non-Transmural MI

A

Necrosis of some layers of heart tissue

127
Q

Contraindications to exercise after MI

A

Acute MI (1-2 days w/o physician approval)

Unstable angina

ECG with abnormalities

Signs and symptoms of MI

Poor Oxygen saturation

Hemoglobin less than 8

Acute infection

128
Q

Right Vs Left CHF – clinical manifestations

A

Left: Progressive dyspnea, Frothy pink sputum, cerebral hypoxia (irritability, restlessness, confusion, impaired memory, sleep disturbances)

Right: Dependent edema, JVD, Abdominal pain and distention

People can have both.

129
Q

What is this called?

A

Jugular venous distention

130
Q

Dilated Cardiomyopathy - symptoms

A

Symptoms: Fatigue, weakness, chest pain (not like unstable angina)

BP: Normal or Low

131
Q

Hypertrophic Cardiomyopathy - Symptoms

A

Symptoms: Asymptomatic, exacerbated during exercise, increased left ventricular pressure, dyspnea

Presenting symptom: Sudden death

132
Q

Peripartum cardiomyopathy

A

Symptoms:
- Orthopnea, cough, palpations, high BP
- Be careful: these may not be present right after the delivery and may take several weeks after delivery

(Weakness of heart)

133
Q

Mitral Regurgitation – Clinical Manifestations

A

Asymptomatic to dyspnea symptoms (Orthopnea, Paryoxsmal nocturnal dyspnea)

Fatigue

Right Ventricular Hypertrophy

Asymptomatic until irreversible left ventricular dysfunction

Exertional dyspnea (due to increased left atrial pressure)

Exercise induced fatigue (due to decreased cardiac output)

134
Q

Aortic Insufficiency – Clinical Manifestations

A

Wide pulse pressure (>40)

Systolic HT

Exertional dyspnea

Fatigue

Angina, Palpation, Nocturnal dyspnea

135
Q

Stenosis

A

Narrowing or constriction of the valve, not able to fully open due to scars or abnormal deposits on the valve leaflets

Obstruction of blood flow

Heart chamber must work against it

136
Q

Regurgitation (Insufficiency)

A

Valves DO NOT properly or adequately close in insufficiency

Backward blood flow

Gradual dilation of the heart to increase cardiac output (CO)

137
Q

Infective endocarditis - clinical manifestations

A

Arthralgia

Myalgias

Low-back pain

Clubbing

Splinter hemorrhages

Confusion

138
Q

Rheumatic fever and heart diseases – clinical manifestations

A

Sore throat (Pharyngitis)

Fever

Carditis
- Pericardial inflammation, chest pain, mitral or aortic valve dysfunction

Acute migratory polyarthritis
- Occurs 2 to 3 weeks after the initial cold or sore throat

Migratory arthralgia – knees, shoulder, feet, ankles, elbows, finger

24 hrs. to several weeks

Chorea (Syndenham) – rapid, purposeless, repetitive movements
- Less common
- Occurs after 1 to 3 months of initial sore throat
- Always preceded by polyarthritis
- Last for weeks to years without permanent CNS impairment

Shortness of Breath (SOB)

Subcutaneous nodules
- Bony prominences and extensor surfaces – knee, heel, arms, back of the head
- Nocturnal cough
- Pericarditis – pathogenesis and clinical manifestations
- Most common vitals and their normal ranges – BP, oxygen saturation, RPE, HR

139
Q

What is this?

A

Erythema Marginatum (ring or crescent shaped)
- Evanescent, non-tender, non-puritic rash in trunk and limbs

140
Q

What is this?

A

Pericardial Effusion
- Abnormal excess fluid accumulation between the pericardial layers

141
Q

What is this?

A

Cardiac Tamponade
- Pericardial effusion with an epigastric bulge

142
Q

Do beta blockers and calcium channel blockers change HR? In that case, how would you monitor their CV response to exercise?

A

Beta blockers and Ca+ will lower HR. Monitor patient with RPE.

143
Q

Exercise Considerations – Pacemakers and AICD

A

Demand Pacemakers: HR will rise with intensity of exercise
Fixed: HR will not change
- Keep a lower limit for HR

Automatic Implantable Cardioverter Defibrillator (AICD)
- Will deliver shock with ventricular arrythmias
- Find the HR limit for AICD

May need to provide more than typical 5-10 minutes of cool down period

Irregular HB: >6 isolated HB/min - report to physician

144
Q

Pneumonia - Patho

A

Endotoxins from infecting organism ->

Damage epithelial cells, goblet cells, and bronchial mucous glands, type II pneumocytes ->

Thickening of bronchial walls with edema ->

Decreased mucociliary clearance

Infection of lung parenchyma

145
Q

Pneumonia - S & S

A

**Sudden and sharp pleuritic pain

**Hacking cough

**Productive cough – rust-colored, green purulent

**Decreased chest excursion on the affected side

Slow and mild unnoticeable fever

Complications: Pleural effusion, empyema, lung abscess

146
Q

Chronic Obstructive Pulmonary Diseases (COPD) - Def and Types (2)

A

Progressive airflow limitation that is not fully reversible
- Chronic Bronchitis
- Emphysema

147
Q

Chronic Bronchitis - Patho

A

Inflammation -> Hypertrophy of goblet cells, mucosal glands, and Smooth muscle -> Impaired ciliary function airway -> obstruction -> poor removal of secretion -> Infection => further mucus production

Distal portions affected -> impairs alveolar ventilation, V/Q mismatch, hypoxia (cyanosis), acidosis

148
Q

Chronic Bronchitis - S & S

A

Persistent cough and sputum (morning and evening than midday)

Prolonged expiration & wheezing

SOB, reduced chest expansion

Recurrent infection – fever

Cyanosis

Exercise intolerance

149
Q

Emphysema - Def

A

Enlargement of the air spaces beyond terminal bronchiole with decreased elasticity in the distal airways – airway collapse and air trapping.

150
Q

Emphysema - Patho

A

Air comes in and gets trapped, old air insides stops new air to come in as air is already in. Air isn’t participating in the gas exchange, aka increases dead space

151
Q

Emphysema - S & S

A

Exertional dyspnea to dyspnea at rest

Cough uncommon with little sputum (vs. Chronic bronchitis)

Thin, Tachypnea, prolonged expiration, accessory muscle use

Leaning forward position (diaphragm into a more domed position)

Barrel chest

Nocturnal hypoxemia – decreased sensitivity of chemoreceptors, decreased firing of the intercostal muscles and increased airway resistance – V/Q mismatch – Nocturnal hypoxia

152
Q

Asthma - Def

A

Inflammation and increased smooth muscle contraction of the airways to stimuli

Reversible obstructive lung disease

153
Q

Asthma - Patho

A

Allergen (IgE mediated) & structural changes ->

Vascular congestion
Vascular permeability - Edema
Mucus (tenacious)
Increased bronchial smooth muscle contraction ->

Impaired muco-ciliary function

154
Q

Asthma - S & S

A

Sensation of suffocation or chest tightness – typically the first sign

*Inspiratory and expiratory wheezes

*Non-productive hacking cough to tenacious sputum

Emergency: SBP decreases >10 mm Hg during inspiration, tachycardia, pulsus paradoxus -> Cardiac Arrest if untreated.

155
Q

Bronchiectasis - Patho

A

Inflammation – enzymatic degradation of airway connective tissues

156
Q

Bronchiectasis - S & S

A

Foul smelling sputum, Persistent coughing and large purulent sputum (morning worse)

157
Q

Cystic Fibrosis - Patho

A

Complex and largely unknown

Cl and Na channels effected, elevated

158
Q

Cystic Fibrosis - S & S

A

Cough
Sputum
Fever
Weight Loss
Wheezing

159
Q

TB - Latent and TB disease Patho

A

Mycobacterium TB, Droplet nuclei, Alveoli ->

  1. Immune cells and Granuloma - (Latent TB – Not infectious and seen only in tuberculin test)
  2. TB disease (active infection) – Caseating necrosis, cavity, fibrosis, and calcification of tissues
160
Q

TB - Latent and TB disease Complications

A

Tuberculous spondylitis (Pott Disease)

161
Q

Precautions while treating TB patients

A

KN95, Gloves, Disinfect Stethoscope, hand washing, yearly TB tests, isolation precautions

162
Q

Pulmonary Edema - Symptoms

A
  • Engorged neck (Jugular vein distention) and hand veins –- peripheral edema
  • Severe -> pink frothy sputum

Physical Therapy
- High fowler position with leg dangling – reduce venous return
- Monitor vitals – life threatening in few minutes

163
Q

Pulmonary Embolism - Patho

A

Blood clot in the pulmonary artery
– Obstruction of blood supply to the lung parenchyma

Most common cause: DVT (LE – popliteal or iliofemoral (50%), deep calf veins (5%), 20% UE –subclavian vein)

Most common cause of sudden death in the hospitalized population United States

164
Q

Pulmonary Embolism - Clinical Manifestations

A

Dyspnea (84%)
Deterioration of existing dyspnea (74%)
Pleuritic chest pain (74%)
Apprehension (59%)
Cough (53%)
Tachypnea (92%)

165
Q

What would happen to FEV1/FVC ration in obstructive vs. Restrictive lung conditions?

A

COPD: FEV1 and FVC decreased

Restrictive: FEV1/FVC remain same or slightly decreased

166
Q

Cyanosis – Where would you look for central and peripheral cyanosis?

A

Central – discoloration of the body & mucous membranes (Oral, lips, conjunctivae)
– Arterial saturation is decreased (Inadequate oxygen saturation (deoxyhemoglobin >5.0g/dL) & Decrease in total amount of circulating hemoglobin)

Peripheral - distal extremities
– Arterial saturation may be normal
– Decreased blood supply and perfusion than unsaturated blood

167
Q

Atelectasis PT management – how deep breathing exercises help?

A

Deep breathing open the Kohn’s Pores (Connection between one aveola to another)

168
Q

Which is normal/abnormal?

A

Left: Normal ; Right: Abnormal

169
Q

Hemothorax

A

Blood in pleural space

170
Q

Pneumothorax

A

Air enters into pleural cavity

171
Q

Open pneumothorax

A

Inspiration shift left (mediastinal and trachial)

Expiration shifts right (mediastinal and trachial)

172
Q

Tension pneumothorax

A

Try to seal over open wound over pleural cavity. Air breathed in gets stuck near seal -> building pressure

173
Q

Pericardial effusion vs pleural effusion

A

Pericardial effusion

Buildup of fluid around the heart.

Pleural effusion

a collection of fluid in the pleural space between the membrane encasing the lung and the chest cavity

174
Q

Pleural rub vs. Pericardial rub characteristics

A

Pleural rub creates pain mostly on the lateral part of the chest wall, whereas pain due to pericardial rub is always central in location. The intensity of pleural rub is increased on pressing the diaphragm of the stethoscope over the affected area, whereas there is no such change in case of a pericardial rub.

Cessation of sounds with holding breath (vs. Pericardial friction rub)

175
Q

Exercises for restrictive lung disease

A

Monitor Vitals

Constitutional Symptoms

Bilateral UE D2 Flexion to improve chest wall movement in restrictive lung disease

Pursed Lip breathing/deep breathing

176
Q

O2 Stat Values

A

Normal 95-100%

Low 90-94%

Supplemental O2 req’d <90%

177
Q

Osteoporosis

A

Postmenopausal (Primary, Type 1)
- Decreased Estrogen ->
- Increased Osteoclast activity and Decreased apoptosis ->
- Increased bone resorption

Senile Osteoporosis (type II/Secondary):
- Decline in Alpha 1- hydroxylase activity in the kidney ->
- decline in serum 1,25-dihydroxyvitamin D (1, 25 (OH) 2D) ->
- malabsorption of calcium and secondary hyperparathyroidism ->
- Bone resorption

T Score of -2.5 and lower

178
Q

Osteopenia

A

Low Bone Mass
T: Score: -1.0 and -2.5

179
Q

Osteomalacia

A

Impaired bone mineralization

180
Q

Osteomalacia - Patho

A
  • Vit. D Deficiency
  • Renal Osteodystrophy
    – (CKD, <60 mL/min GFR)
181
Q

Osteomalacia is called what in children?

A

Rickets

182
Q

Signs and Symptoms: Osteomalcia

A

Subtle – delayed diagnosis

Diffuse bone pain and tenderness

183
Q

Paget’s Disease - S & S

A
  • Asymptomatic
  • Pain – itself or arthritis in knee or hip
  • Skull – Enlargement leads to headache, dizziness, hearing loss
  • Spine- tingling and pinched nerves
  • Lower Legs – bowlegs and difficulty in walking

Possibility of Heart Failure

Def: New bone gradually regrow onto old bone

184
Q

Paget’s Disease - Heart Failure

A

due to increased work for heart to supply blood to the newly formed bones

185
Q

Osgood Schlatters Disease

A

Pulling of small bits of immature bone from tibial tuberosity

186
Q

Osgood Schlatter Disease - S & S

A

-Increased Q angle – knock knees/flat foot
- Patella Alta (high patella)
– Patella tracking affected; Patella gets pulled up by quadriceps tendon when the ischial tuberosity breaks off.
- Pain
– Flexion moment – increased stress on the tibial tubercle
- Minor stretching is okay, NOT aggressive

187
Q

What is this called?

A

Osgood Schlatter Disease

188
Q

Osteomyelitis - Pathogenesis

A
  • Inflammation of the bone by infection – Bacterial, Fungus, parasites and viral
  • Staphylococcus Aureus
189
Q

Osteomyelitis - How do children get it?

A

Sharp turn of vasculature leads to blood slowing down. Results in microabscess occuring at this location.

190
Q

Osteomyelitis - Why do adults not get this as much?

A

Rare as adults do not have same blood supply

191
Q

Osteomyelitis - When to refer?

A

Refer patient if they have pus or if they do not have medication. Easier to treat because of more blood circulation.

192
Q

Osteomyeltiis Clinical Manifestation - Children

A

Unexplained cellulitis (painful skin infection with swelling and warmth)

193
Q

Osteomyelitis - Acute OM

A
  • Low grade fever – systemic
  • Pain – intermittment/constant/deep
    – Aggravated with activity (increases with weight bearing)
    – Periosteum – rapid development of pain, fever, swelling
  • Spine and Abcess – rigidity, instability
    – Psoas abcess – painful hip extension (antalgic gait)
    – Myelopathy, Meningitis
194
Q

Osteomyelitis - Chronic OM

A
  • Local pain, swelling, limping
  • Sausage Toe – Good sensitivity and specificity in diabetes
195
Q

What is this called?

A

Osteomyelitis

196
Q

Avascular necrosis - which movements are affected

A

AROM pain – hip internal rotation and flexion and adduction

197
Q

Legg-calve-perthes disease - which movements are affected

A

AROM limitation in hip abduction and rotation (Internal rotation)

198
Q

OA - Pathogenesis

A

Wear and Tear – Passive process

Active process
- Matric Metablloproteinases and cyotkines lead to loss of type 2 collagen -> Catabolic degredation of cartilage -> reduced frictionless movements

199
Q

OA Management

A

Pharmalogical: NSAIDs

Surgical

Walking

200
Q

What activities and exercises are strongly recommended for OA management according to 2019 guidelines?

A

Walking

201
Q

Gout

A

Uric acid crystalizes (mono sodium urate crystal – MSU)

202
Q

Gout - S & S

A

*Tophi – Subcutaneous nodules of sodium urate crystal (In image)
*Fewer
*Chills
*Malaise
*Pain – Intense “on fire”
*Swelling

203
Q

Sprain and Stain – degrees

A

*First degree (mildest) – little tearing, pain or swelling; joint stability is good.

*Second degree – broadest range of damage, with moderate instability and moderate to severe pain and swelling.

*Third degree (most severe) – ligament is completely ruptured; joint is unstable; severe pain and swelling; other tissues are often damaged

204
Q

Osteochondritis Dissecans

A

Repetitive stress -> Ischemia and subchondral growth cessation -> Necrosis -> Articular cartilage softening -> Fragment seperation

205
Q

What is this?

A

Osteochondritis Dissecans

206
Q

Muscular dystrophy – Gowers sign and PT exercise modifications

A

Gowers sign
-Lumbar lordosis
-Toe walking – calf, anterior tibial, peroneal
-Pseudohypertrophy of calf muscles
-Scoliosis

PT Exercise Modifications
-No strenuous exercise
-Low weight, high repitions
-Encourage mobility

207
Q

Most common muscles weakness associated with muscular dystrophy

A

Lumbar and gluteal muscles

208
Q

Rhabdmyolysis - Patho

A

Muscle damage - Myoglobin -> block kidney-> Kidney failure

Statin Induced Myopathy (cholesterol medication control – statin; Ex: Prozac)

209
Q

Rhabdomyolysis - S & S

A

Tea colored or cola colored urine

210
Q

Rhabdomyolitis - Exercise Modifications

A

Allow for athletes to properly hydrate when exercising at a high intensity especially when it is hot out to help prevent dehydration. Exercise induced muscle damage can be a sign for rhabdomyolysis be careful.

211
Q

Myositis Ossificans - PT Implications

A

Contraindication:
- Aggressive Stretching

Allowed:
- Passive and active movements and strengthening

212
Q

What is this?

A

Myositis Ossificans

213
Q

DOMS and EIMD – Exercise modifications

A

New exercise during training - Progressive approach of exercise in 1 to 2 weeks

Delayed Onset of Muscle Soreness (DOMS) - 24 to 48 hours

Exercise Induced Msucle Damage (EIMD)
- Inflammatory markers of muscle damage - inflammation

214
Q

Hypothyroidism - Patho

A

Iodine Deficiency or Inflammation/Hashimoto’s Thyroiditis ->

Reduced functional thyroid gland ->

Decreased T3 and T4 ->

Hypersecretion of TSH (Due to little T3, T4 because of no iodine) ->

Large production of Thyroglobulin (colloid) -> Glandular enlargement (Colloid Goiter)

215
Q

Hypothyroidism - S & S

A
  • Weight gain due to decreased lip metabolism
  • Fatigue and increased sleep (Due to no energy conversion)
  • Prolonged DTR (especially Achilles)
  • Bradycardia
  • Myxedema
  • Constipation
216
Q

Hyperthyroidism - Patho

A

Graves Disease (85%), adenoma, thyroid cancer

GD
Increases grandular size ->

Increases synthesize of thyroid hormone ->
- Increased T3 and T4

Results in Goiter

217
Q

Hyperthyroidism - S & S

A

Myopathy – difficulty ambulaating, stairs, raising from chair

Heat intolerance

Diarrhea

Weight loss

Tremor

Increased DTR

Atrial fibrillation

Exophthalmos – Protriding eyes

Hair loss

218
Q

Hyperthyroidism Acute flareup

A

Can be life threatening

  • Fever
  • Severe tachycardia
  • Delirum
  • Dehydration
  • extreme irritability
219
Q

What is goiter, grave’s disease, and exophthalmos?

A

Goiter
- Glandular enlargement (Colloid Goiter)

Grave’s Disease
- Autoimmune Disease

Exophthalmos
- Protruding Eyes
- Lots of fluid on the backside of the eye

220
Q

What is this?

A

Exophthalmos

221
Q

Would you do exercise when someone has exophthalmos?

A

No! Document and refer! This can lead to stroke.

222
Q

Hyperparathyroidism

A

Excess Calcium in the blood (binded to phospate)
- Osteoclastic activity -> osteoporosis and fractures
- High Ca+ in renal tubules – Nephrocalcinosis (kidney disease) - stone formation

Decreased Vitamin D, leads to less Calcium absorption

223
Q

Hyperparathyroidism - Clinical Manifestations

A

Mild to severe proximal muscle weakness of the extremities

Muscle atrophy

224
Q

Cushing’s Syndrome - PT Implications

A

Excess Cortisol

  • Stength Training – Large Groups (Avoid extreme stress)
  • Education on proper body mechanics
  • Jogging is not recommended
  • Manipulation – Caution (Bones are weak)
225
Q

What is this?

A

Cushing’s Syndrome

226
Q

Fluid imbalance – dehydration signs and symptoms

A

Fluid Deficit – loss of fluids (hemorrhage, burns, diarrhea, diaphoresism vomiting)
-Poor skin turgor
-Weight loss
-Dryness of mouth, throat, face and absense of sweat - thirst

227
Q

Actions – Glucose and Insulin

A

Glucose: Provide energy for cells: muscle, fat, liver and brain.

Insulin: Allows for glucose to be utilized by opening channels

228
Q

Type 1 DM - Patho

A
  • Auto-immune disease (Type 4 HS)
  • Beta Cell destruction in pancreas
  • No insulin production (absolute insulin deficiency)
  • Ketoacidosis (Excess ketones create metabolic acidosis)
229
Q

Type II DM - Patho

A

Normal or excess insulin production

Reduced number and function of insulin receptors – insulin resistance
- Increase blood glucose, cell’s don’t receive glucose

230
Q

Hypoglycermia - Cardinal Signs

A

Rapid onset (minutes) - Hypoglycemia

Difficulty concentrating, speaking, focusing

Shaky

Shallow respiration

231
Q

Hyperglycemia - Cardinal Signs

A

Gradual (days) - Hyperglycemia

Lethargic

Confused

Thirsty

Dry

232
Q

Dupuytren contracture

A

More common in type 1 than type 2

Flexion contracture, nodules (distal palmar crease), thickening cord of palmar fascia – usually third and fourth digits

233
Q

What is this?

A

Dupuytren contracture

234
Q

Diabetic ketoacidosis

A
  • Blood glucose >300 mg/dL (250-300 is caution)
  • Thirst (very dry mouth)
  • Hyperventilation
  • Fruity odor breath
  • Confusion
  • Dehydration
  • Arterial pH <7.30
235
Q

Insulin shock

A
  • Blood Glucose <70 mg/dL
  • Perspiration
  • Irritability/nervousness
  • Weakness
  • Hunger
  • Fatigue
  • Numbness or lips/tongue
236
Q

DM - Blood Glucose Levels

A

Safe Zone: 100-250 mg/dL

Goal:

Type 1: 90 to 130

Type 2: Up to 150

250-300: CAUTION

237
Q

DM - PT Implications

A

Encourage fluid intake before exercise

Exercise after 1 hour of a meal

Do not exercise without a meal for 2 hours

Do not inject short acting insulin to the site for 1 hour after exercise – quick absorption

Monitor glucose before and after exercise
- BG decrease when doing strength training
- Cardio – Only for heart, oxidative system

238
Q

Sickle Cell Disease - S & S

A

Anemia

Severe infection

Headache

Enlarged organs

Acute episode of SCD
- Hand foot syndrome (painful swelling of hands and feet)

239
Q

Anemia - PT Implications

A

Hemoglobin
- <8 g/dL Symptom based approach (monitor vitals especially Spo2)
- <5-7 g/dL (low critical value – HF or death)

Hematocrit
- Male: 42-52%
- Female: 37-47%
- <25% symptoms based approach

Use RPE and gradually increase exercise – poor exercise tolerance

Very careful when using cold
- Cold increases VC and sickling – contraindication for SCD

240
Q

Anemia - S & S

A

Fatigue and weakness with minimal exertion

Bleeding – gums, mucous membranes, skin

241
Q

Thrombocytopenia

A

Decreased platelets – increases likelihood for bleeding

242
Q

Thrombocytopenia - S & S

A

Mucosal bleeding – brushing teeth

Respiratory tract – blowing nose

Uterus – excessive menstrual bleeding

Brain – external hematoma

243
Q

Thrombocytopenia - PT Implications

A

Bleeding? Apply ice and pressure

No strenuous exercise allowed

Blood pressure cuff – CAUTION (Give LOTS of time in between each measure)

Mechanical compression and pneumatic pump – contraindicated

Keep eye on aspirin intake – need physician approval

<20 k/uL: Symptom based approach

20,000 - 40,000: Low intensity exercise with no weight or resistance up to 2 lbs
- No resistance during statioonary biking

10,000: Spontaneous CNS, Respiratory tract, and GI bleeding

Ambulation precautions – get clearance from the healthcare team for ambulation

244
Q

Leukemia S & S - Acute and Chronic

A

Acute
* Spontaneous bleeding – skin and mucosal surfaces
* Mid-cycle menstrual bleeding or heavy menstrual bleeding
* Leukemia cutis – infiltration of the cancer cells to skin

Chronic
* Nonspecific
* Weight loss
* Splenomegaly (Left upper quadrant pain)
* Chronic to acute leukemia and die within months

245
Q

What is this?

A

Leukemia

246
Q

Lymphoma - S & S

A

Drenching night sweats

Unexplained weight loss (>10% of BW) over six months

Unexplained fever

Enlarged Lymph nodes

247
Q

Polycythemia Vera

A

Neoplasm of bone marrow -> Increased RBC production

248
Q

Leukemia

A

Neoplasm of WBC

Infiltration and spread to blood stream and organs

249
Q

Multiple Myeloma

A

Primary malignant neoplasm of plasma cells

Second most common hematologic cancer

250
Q

Lymphoma

A

Neoplasm of the lymphatic system

Hodgkins Lymphoma
- Upper body
- Reed-Sternberg Cell

Non-Hodgkin’s Lymphoma
- Abdomen, groin
- More common, poor prognosis

251
Q

Malignant Melanoma

A

Neoplasm of the skin (Melanocytes – synthesize melanin) cells

252
Q

Normal and abnormal lymph node identification

A

Normal: soft, rubbery, mobile, small (<1cm)

Abnormal: Tender, warm, enlarged (but mobile and soft)

Malignant: Enlarged, hard, non-tender or non-mobile

253
Q

Dermatitis vs. cellulitis

A

Dematitis: Eczema
- Contact dermatitis

Cellulitis – Infection
- Rashes often with pain and fever

Caution with redness due to orthotics and prothetics

254
Q

What happens to Calcium absorption, Vit. D, Phosphorus, Parathyroid hormone, Calcitonin levels in Osteoporosis and Hyperparathyroidism?

A

Parathyroid hormone increase

Activate Osteoclasts break down bone Ca and phosphorus comes out od bone (free calcium)

Ca has high tendensy to attach to phosphorus but in blood stream is low

Leads to more PTH to break things down more because low in blood.

Total calcium level is elevated in this test – calcium level is high

Total phosphorus level is high

PTH is high

Vitamin D deficiency leads to no absorption of Ca from interstine.

Calcitonin is the opposite of PTH don’t have strong evidence what happens with interactions of these other minerals.

255
Q

What do cancer cells secrete?

A

PTH like hormone

Pathology (7 decks)

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