Final Flashcards

Question

Implications of PT - Chronic Kidney Disease

Answer 1

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)

Answer 2

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

Answer 3

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

Answer 4

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

Answer 5

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

Answer 6

* 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)

Answer 7

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

Answer 8

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

Answer 9

Inguinal Hernia - Intraabdominal pressure can lead to this Sliding Hernia - Heartburn in 30-60 minutes after meal Large Sliding hernia - Substernal pain

Answer 10

Avoid flat supine position and exercise that requires valsalva maneuver Educate about intraabdominal pressure (Flex: Breath in; Extend: Breath out

Answer 11

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

Answer 12

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

Answer 13

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

Answer 14

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)

Answer 15

Disorder to the mucosa (not muscularis mucosa) Acute: Hemorrhagic or erosive (NSAIDS and Asprin)

Answer 16

Epigastric pain with abdominal distension, heartburn, Occult GI bleeding

Answer 17

Erosion or ulcer of stomach or duodenum due to mucosal insult

Answer 18

-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

Answer 19

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

Answer 20

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

Answer 21

Dermatitis Herpetiformis

Answer 22

- Crohn's Disease - Ulcerative Colitis

Answer 23

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**

Answer 24

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

Answer 25

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))

Answer 26

Dry lips, hands Headache Brittle hair Incoordination Disorientation

Answer 27

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

Answer 28

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

Answer 29

Fecal matter goes inside and causes inflammation in intestines

Answer 30

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.**

Answer 31

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

Answer 32

Cardinal Sign: Bright Red Stool (rectum) Diverticulosis, anal fissures, and hemorrhoids

Answer 33

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**

Answer 34

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

Answer 35

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

Answer 36

Inflammation of the liver

Answer 37

Virus (acute infectious condition) Infection route: Fecal-oral, contaminated food or water, person-person contact

Answer 38

- Serum Hepatitis - **Blood, body fluids/tissues, oral or sexual contact** - Can lead to cancer - Second major cause of cirrhosis

Answer 39

Same as Hep B Virus! Blood, body fluids/tissues, oral or sexual contact

Answer 40

- Jaundice - Asterixis - **Dark Urine** - **Spider angiomas (branched dialations of supericial capillaries)** - **Pain: Right shoulder pain** - **Right Upper Quadrant Pain** - GI symptoms

Answer 41

Aka Icterus Overproduction of bilirubin

Answer 42

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**

Answer 43

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**

Answer 44

**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**

Answer 45

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

Answer 46

Chronic Pancreatitis Chronic inflammation -> irreversible changes **Cause: Alcohol (>50% of cases) metabolite acts as a toxin**

Answer 47

**Epigastric pain – radiates to back** **Pain worsens with meal but relieved knee to chest or forward bending**

Answer 48

**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**

Answer 49

Formaiton of blood clots

Answer 50

Arterial – Platelet rich (MI, CVA, PAD) -> amputation -> death Venous – RBCs and Fibrin (Ex: SVT, DVT

Answer 51

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

Answer 52

Measures how fast blood can clot Normal: Range 11 to 13.5 seconds

Answer 53

Monitor patient response to anticoagulants

Answer 54

Dissolution of Clot -> Fibrin threads (D-dimer) (>500 ng/mL) -> moderate to high risk (DVT)

Answer 55

-2 to 0: Low probability 1-2: Moderate > or = 3: High

Answer 56

Blood escaping from a ruptured blood vessel

Answer 57

subdural hematoma

Answer 58

Ecchymosis

Answer 59

Purpura (Right) and Petechiae (Left – small)

Answer 60

Accumulation of fluid within interstitial tissues or within body cavities

Answer 61

Generalized Swelling

Answer 62

Liver failure Kidney failure Right sided heart failure

Answer 63

- 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

Answer 64

Often associated with non-lymphatic obstruction Low protein, high water. Easier to treat.

Answer 65

Often with chronic lymphatic obstruction Harder to treat. High protein.

Answer 66

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

Answer 67

Tachycardia Tachypnea (shallow/narrow breaths) Cool extremities Decreased pulses Decreased urine output Altered mental status

Answer 68

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

Answer 69

**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%)**

Answer 70

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

Answer 71

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.

Answer 72

Autonomic nervous dysfunction (Smooth Muscle – heart and BV – heart-beat, widening BV) Can cause hypotension: L-dopa, Nitrates, Calcium channel blockers

Answer 73

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

Answer 74

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

Answer 75

1. Loss of smooth muscle cells 2. Increased matrix metalloproteinase – degradation of elastin Plague -> Erode -> Stretching of inner/outer layer -> Sac formation

Answer 76

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

Answer 77

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**

Answer 78

Sudden Severe Headache Nausea and vomiting Pain above and behind one eye Sensitivity to light Drooping eye lid

Answer 79

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

Answer 80

Hospitalization/Immobilization Cardiac Failure Surgery Fracture or dislocation Local trauma Smoking Genetics Neoplasm Diabetes Mellitus Obesity Previous DVT >60 years old

Answer 81

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

Answer 82

Compression and anticoagulation are standard Anticoagulant therapy - Monitor for blood in urine, stool, teeth, or any bleeding

Answer 83

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

Answer 84

Varicose Veins

Answer 85

Dialted, tortuous, elongated veins beneath skin upon standing

Answer 86

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.

Answer 87

Hemosiderin – stores iron in tissues Venous stasis ulcer (80% of ulcers) Can be very painful

Answer 88

**Can lead to silent death Depends on size and location: Pleuritic chest pain – inhalation and exhalation Hemoptysis (cough up blood)**

Answer 89

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

Answer 90

* Stable Angina * Unstable Angina

Answer 91

**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

Answer 92

**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)**

Answer 93

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

Answer 94

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

Answer 95

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)**

Answer 96

Myocardial Infarction

Answer 97

Best predictor of Heart Attacks (MI) - Waist to Hip Ratio Best predictor of CHF - Pulse Pressure 40 = Healthy >40 = Abnormal

Answer 98

Non-contractile tissue, electrically inert Dead cells removed and fibrous scar formation

Answer 99

Necrosis of entire heart tissue

Answer 100

Necrosis of some layers of heart tissue

Answer 101

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

Answer 102

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.

Answer 103

Jugular venous distention

Answer 104

Symptoms: Fatigue, weakness, chest pain (not like unstable angina) BP: Normal or Low

Answer 105

Symptoms: Asymptomatic, exacerbated during exercise, increased left ventricular pressure, dyspnea Presenting symptom: Sudden death

Answer 106

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)

Answer 107

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)**

Answer 108

**Wide pulse pressure (>40)** **Systolic HT** Exertional dyspnea Fatigue Angina, Palpation, Nocturnal dyspnea

Answer 109

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

Answer 110

Valves DO NOT properly or adequately close in insufficiency Backward blood flow Gradual dilation of the heart to increase cardiac output (CO)

Answer 111

Arthralgia Myalgias Low-back pain Clubbing Splinter hemorrhages Confusion

Answer 112

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

Answer 113

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

Answer 114

Pericardial Effusion - Abnormal excess fluid accumulation between the pericardial layers

Answer 115

Cardiac Tamponade - Pericardial effusion with an epigastric bulge

Answer 116

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

Answer 117

**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

Answer 118

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

Answer 119

**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

Answer 120

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

Answer 121

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

Answer 122

Persistent cough and sputum (morning and evening than midday) Prolonged expiration & wheezing SOB, reduced chest expansion Recurrent infection – fever Cyanosis Exercise intolerance

Answer 123

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

Answer 124

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

Answer 125

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

Answer 126

Inflammation and increased smooth muscle contraction of the airways to stimuli Reversible obstructive lung disease

Answer 127

Allergen (IgE mediated) & structural changes -> Vascular congestion Vascular permeability - Edema Mucus (tenacious) Increased bronchial smooth muscle contraction -> Impaired muco-ciliary function

Answer 128

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.

Answer 129

Inflammation – enzymatic degradation of airway connective tissues

Answer 130

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

Answer 131

Complex and largely unknown Cl and Na channels effected, elevated

Answer 132

Cough Sputum Fever Weight Loss Wheezing

Answer 133

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

Answer 134

Tuberculous spondylitis (Pott Disease)

Answer 135

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

Answer 136

- 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

Answer 137

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

Answer 138

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

Answer 139

COPD: FEV1 and FVC decreased Restrictive: FEV1/FVC remain same or slightly decreased

Answer 140

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**

Answer 141

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

Answer 142

Left: Normal ; Right: Abnormal

Answer 143

Blood in pleural space

Answer 144

Air enters into pleural cavity

Answer 145

Inspiration shift left (mediastinal and trachial) Expiration shifts right (mediastinal and trachial)

Answer 146

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

Answer 147

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

Answer 148

**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)**

Answer 149

Monitor Vitals Constitutional Symptoms Bilateral UE D2 Flexion to improve chest wall movement in restrictive lung disease Pursed Lip breathing/deep breathing

Answer 150

Normal 95-100% Low 90-94% Supplemental O2 req’d <90%

Answer 151

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

Answer 152

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

Answer 153

Impaired bone mineralization

Answer 154

- Vit. D Deficiency - Renal Osteodystrophy -- (CKD, <60 mL/min GFR)

Answer 155

Subtle – delayed diagnosis Diffuse bone pain and tenderness

Answer 156

* 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

Answer 157

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

Answer 158

Pulling of small bits of immature bone from tibial tuberosity

Answer 159

-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

Answer 160

Osgood Schlatter Disease

Answer 161

- Inflammation of the bone by infection – Bacterial, Fungus, parasites and viral - Staphylococcus Aureus

Answer 162

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

Answer 163

Rare as adults do not have same blood supply

Answer 164

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

Answer 165

Unexplained cellulitis (painful skin infection with swelling and warmth)

Answer 166

- 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

Answer 167

- Local pain, swelling, limping - **Sausage Toe – Good sensitivity and specificity in diabetes**

Answer 168

Osteomyelitis

Answer 169

AROM pain – hip internal rotation and flexion and adduction

Answer 170

AROM limitation in hip abduction and rotation (Internal rotation)

Answer 171

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

Answer 172

Pharmalogical: NSAIDs Surgical Walking

Answer 173

Uric acid crystalizes (mono sodium urate crystal – MSU)

Answer 174

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

Answer 175

*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

Answer 176

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

Answer 177

Osteochondritis Dissecans

Answer 178

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**

Answer 179

Lumbar and gluteal muscles

Answer 180

Muscle damage - Myoglobin -> block kidney-> Kidney failure Statin Induced Myopathy (cholesterol medication control – statin; Ex: Prozac)

Answer 181

Tea colored or cola colored urine

Answer 182

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.

Answer 183

Contraindication: - Aggressive Stretching Allowed: - Passive and active movements and strengthening

Answer 184

Myositis Ossificans

Answer 185

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

Answer 186

**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)**

Answer 187

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

Answer 188

Graves Disease (85%), adenoma, thyroid cancer GD Increases grandular size -> Increases synthesize of thyroid hormone -> - Increased T3 and T4 Results in Goiter

Answer 189

Myopathy – difficulty ambulaating, stairs, raising from chair Heat intolerance Diarrhea Weight loss Tremor Increased DTR Atrial fibrillation Exophthalmos – Protriding eyes Hair loss

Answer 190

Can be life threatening * Fever * Severe tachycardia * Delirum * Dehydration * extreme irritability

Answer 191

Goiter - Glandular enlargement (Colloid Goiter) Grave’s Disease - Autoimmune Disease Exophthalmos - Protruding Eyes - Lots of fluid on the backside of the eye

Answer 192

Exophthalmos

Answer 193

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

Answer 194

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

Answer 195

Mild to severe proximal muscle weakness of the extremities Muscle atrophy

Answer 196

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

Answer 197

Cushing's Syndrome

Answer 198

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

Answer 199

Glucose: Provide energy for cells: muscle, fat, liver and brain. Insulin: Allows for glucose to be utilized by opening channels

Answer 200

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

Answer 201

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

Answer 202

Rapid onset (minutes) - Hypoglycemia Difficulty concentrating, speaking, focusing Shaky Shallow respiration

Answer 203

Gradual (days) - Hyperglycemia Lethargic Confused Thirsty Dry

Answer 204

More common in type 1 than type 2 Flexion contracture, **nodules** (distal palmar crease), thickening cord of palmar fascia – usually **third and fourth digits**

Answer 205

Dupuytren contracture

Answer 206

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

Answer 207

* Blood Glucose <70 mg/dL * Perspiration * Irritability/nervousness * Weakness * Hunger * Fatigue * Numbness or lips/tongue

Answer 208

Safe Zone: 100-250 mg/dL Goal: Type 1: 90 to 130 Type 2: Up to 150 250-300: CAUTION

Answer 209

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

Answer 210

Anemia Severe infection Headache Enlarged organs Acute episode of SCD - Hand foot syndrome (painful swelling of hands and feet)

Answer 211

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

Answer 212

Fatigue and weakness with minimal exertion Bleeding – gums, mucous membranes, skin

Answer 213

Decreased platelets – increases likelihood for bleeding

Answer 214

Mucosal bleeding – brushing teeth Respiratory tract – blowing nose Uterus – excessive menstrual bleeding Brain – external hematoma

Answer 215

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

Answer 216

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

Answer 217

Drenching night sweats Unexplained weight loss (>10% of BW) over six months Unexplained fever Enlarged Lymph nodes

Answer 218

Neoplasm of bone marrow -> Increased RBC production

Answer 219

Neoplasm of WBC Infiltration and spread to blood stream and organs

Answer 220

Primary malignant neoplasm of plasma cells Second most common hematologic cancer

Answer 221

Neoplasm of the lymphatic system Hodgkins Lymphoma - Upper body - Reed-Sternberg Cell Non-Hodgkin's Lymphoma - Abdomen, groin - More common, poor prognosis

Answer 222

Neoplasm of the skin (Melanocytes – synthesize melanin) cells

Answer 223

Normal: soft, rubbery, mobile, small (<1cm) Abnormal: Tender, warm, enlarged (but mobile and soft) Malignant: Enlarged, hard, non-tender or non-mobile

Answer 224

Dematitis: Eczema - Contact dermatitis Cellulitis – Infection - Rashes often with pain and fever Caution with redness due to orthotics and prothetics

Answer 225

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.

Answer 226

PTH like hormone