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Neuromuscular > Foundational Info > Flashcards

Foundational Info Flashcards

1
Q

Shoulder abduction, myotomes patterns

A

C5

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2
Q

Shoulder adduction, myotomes patterns

A

C6, C7, C8

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3
Q

Elbow flexion, myotomes patterns

A

C-5, C6

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4
Q

Elbow extension, myotomes patterns

A

C6, C7

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5
Q

Wrist flexion and extension, myotomes patterns

A

C6, C7

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6
Q

Wrist, supination, myotomes patterns

A

C6

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6
Q
A
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7
Q

Wrist pronation, myotomes patterns

A

C7, C8

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8
Q

Digital flexion and extension myotome

A

C7. C8

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9
Q

Finger adduction and abduction and finger lateral and medial abduction and adduction myotome patterns

A

T1

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10
Q

C4 Dermatome landmarks

A

Shoulders

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11
Q

C6 Dermatome landmarks

A

Thumb

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12
Q

C7 Dermatome landmarks

A

Middle finger

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13
Q

C8 Dermatome landmarks

A

Pinky

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14
Q

T2 Dermatome landmarks

A

axillary

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15
Q

T4 Dermatome landmarks

A

Nipples

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16
Q

T10 Dermatome landmarks

A

Belly button

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17
Q

L4 Dermatome landmarks

A

Inner ankle

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18
Q

L5 Dermatome landmarks

A

Outer calf, and first three toes

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19
Q

S1 Dermatome landmarks

A

Ankle and last two toes

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20
Q

Elbow flexion

A

4
Biceps brachii, coracobrachialis, brachialis, brachioradialis

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21
Q

Elbow extension

A

2
Triceps brachii, Anconeus

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22
Q

Wrist flexion

A

4
Flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum profundus

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23
Q

Wrist extension

A

4
Extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, extensor indicis

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24
Q

Forearm supination

A

3
Biceps brachii, brachioradialis, supinator

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25
Q

Forearm pronation

A

4
Brachioradialis, Anconeus, pronator teres, pronator quadratus

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26
Q

Radial deviation

A

3
Flexor carpi radialis, extensor carpi radialis longus, extensor carpi radialis brevis

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27
Q

Ulnar deviation

A

2
Flexor carpi ulnaris, extensor carpi ulnaris

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28
Q

Finger flexion

A

8
Flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus, flexor pollicis brevis, flexor digit minimi, palmar interossei, dorsal interossei, lumbricals

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29
Q

Finger extension

A

6
Extensor digitorum, extensor digiti minimi, extensor indices, Palmar interossei, dorsal interossei, lumbricals

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30
Q

Thumb abduction

A

2
Abductor pollicis longus, abductor pollicis brevis

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31
Q

Thumb adduction

A

Adductor pollicis

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32
Q

Thumb extension

A

3
Abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus

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33
Q

Thumb flexion

A

2
Flexor pollicis brevis, Flexor pollicis longus

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34
Q

Thumb opposition

A

3
Flexor pollicis brevis, abductor pollicis brevis, opponens pollicis

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35
Q

Hip ER Myotomes

A

S1

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36
Q

Hip IR Myotomes

A

L5

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37
Q

Hip Abduction Myotomes

A

L5

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38
Q

Hip Adduction Myotomes

A

L3

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39
Q

Hip Flexion Myotomes

A

L2

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40
Q

Hip Extension Myotomes

A

S2

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41
Q

Knee Flexion Myotomes

A

S2

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42
Q

Knee Extension Myotomes

A

L3

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43
Q

Dorsiflexion Myotomes

A

L4

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44
Q

Plantarflexion

A

S1

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45
Q

Eversion

A

S1

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46
Q

Inversion

A

L4

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47
Q

Toe Extension

A

L5

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48
Q

Toe Flexion

A

S2

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49
Q

Deep External rotators

A

-Piriformis
-obturator internus
-superior and inferior gemellis
-quadrate femoris

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50
Q

Quad Muscles

A

-Rectus Femoris
-Vastus medialis
-Vastus lateralis
-Vastus intermedius

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51
Q

Medial Thigh/ Adductors

A

-Gracilis
-Adductor longus
-Adductor brevis
-adductor magnus
-Obturator externus

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52
Q

Posterior thigh/Hanmstrings

A

-Biceps Femoris (short and long head)
-Semitendinosus
-Semimembranosus

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53
Q

Triceps Surae

A

-Gastrocnemius
-Soleus
-Plantaris

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54
Q

Deep Posterior Leg

A

-Popliteus
-Tibialis Posterior
-Flexor Digitorum Longus
-Flexor Hallucis Longus

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55
Q

Lateral Lower Leg

A

Fibular Longus and Brevis

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56
Q

Anterior Lower Leg

A

-Tibial anterior
-Extensor hallucis Longus
-Extensor Digitorum Longus
-Fiburlaris Tertius

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57
Q

Flow of arterial supply

A

-Abdominal Aorta
-Common iliac
-External iliac———–Internal iliac (to PF)
-(@inguinal lig) Femoral A.–Deep Femoral (circumflex)
-(@hiatus) Popliteal A.
-(@soleal line) Pos. Tib A. —— Fibular A.
-Ant. Tib A.
-Dorsalis Pedis

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58
Q

Sciatic Nerve Pathways

A

-travel buddy: posterior cutaneous
-Tibial———————-Common Fibular
-med & lat plantar—- Superficial & deep

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59
Q

Posterior incision hip replacement precautions

A

No flexion past 90°, no internal rotation past neutral, no adduction past neutral, keep pillows in between knees during long-term positioning

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60
Q

Anterior incision hip replacement precautions

A

No extension passed 90°, no external rotation past neutral, no abduction past neutral, please pillows on outsides of legs, it during long-term positioning

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61
Q

Right Coronary Artery

A

-Supplies right ventricle, AV node and SA node
-Right posterior descending
-Right marginal

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62
Q

Left Coronary Artery (supplies)

A

-supplies left ventricle, L atrium, septum, SA node

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63
Q

SA Node

A

-sets heart at pace of >100 without other input
-Susceptible to disease due to pericarditis, occulsion

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64
Q

Cardiac Output

A

-CO= HR x SV
-5-6L at rest, can increased 4-7x with exercise
-Effects systolic BP

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65
Q

Blood Pressure

A

BP=HR x SV x Total peripheral Resistance
TPR affects diastolic BP

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66
Q

Mean Arterial Blood Pressure

A

-average pressure in the systemic system, perfusion of organs and peripheral tissues
MAP= DBP + 1/3 (SBP-DBP)
-Normal: 70- 93 mmHg
-cautions <60mmHg

Determined By:
-BV, CO, Peripheral resistance, distribution of blood in veins

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67
Q

Pulse Pressure

A

SBP-DBP, difference
-how hard heart is working
>60 working too hard; HTN
<40 failing heart; cardiomyopathy;shock

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68
Q

BP Normal

A

<120/<80

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69
Q

BP Elevated

A

120-129/<80

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70
Q

High BP Stage 1

A

130-139/80-89

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71
Q

High BP Stage 2

A

> 140/>90

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72
Q

Hypertensive Crisis

A

> 180/>120

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73
Q

HR

A

-Beats per minute

->120bpm @ rest, not enough time to refill, decreases CO
-<45bpm @ rest not enough CO, low bp

Affected by: Baroreceptors, ANS, endocrine, integrity of the system, temperature, emotions

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74
Q

SV

A

-amount of blood pumped out each beat
-Afterload-Preload, heart contractility
-increases 40-60% during exercise

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75
Q

Cardiac Preload (& determinants)

A

-End diastolic volume: amount of left ventricular blood volume prior to contraction

Dependent on:
-venous return, BV, LA contraction, Starling law

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76
Q

Cardiac Afterload

A

-Amount of resistance encountered by left ventricle

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77
Q

Ejection Fraction

A

Ejection Fraction= SV/EDV
-55-70%
-Low EF indicates systolic heart failure: <40
-EF can be preserved with overall decrease in BV, weak heart increases backflow that increases SV

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78
Q

Hypoxia

A

O2 concentration of tissues

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79
Q

Hypoxemia

A

O2 concentration of blood

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80
Q

Fick equation

A

-VO2= HR x SV x (a-vO2 diff)

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81
Q

Ventilation to Perfusion Ratio (V/Q)

A

-blood flow to alveoli must match ventilation or =hypoxemia
-changes with posture
-Norm: 0.8

Reduced: decreased ventilation to perfusion, blood shunted to other parts of the lung, vasoconstriction at arterioles to reduce BV, corrected with O2

Increased: increased ventilation to perfusion, vasodilation to increase BV, dead space

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82
Q

Causes of Cardiac Muscle Disease: Hypertension

A

Increased BP
-increased workload w/o increased blood supply
-decreased BV
-hypertrophy of myocardium that cannot relax well
-BV damage

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83
Q

Causes of Cardiac Muscle Disease: Coronary Artery Disease

A

-2nd most common cause of CMD
-supply and demand issue

-lipid deposits: atherosclerosis
-scar formation: decreases contractility

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84
Q

Causes of Cardiac Muscle Disease: Myocardial Infarction

A

-irreversible myocardial necrosis
-most commonly affects left ventricle

PT
-Increased Troponin, CK-MB that needs to come down
-ST elevation on ECG “Stimmy”

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85
Q

Causes of Cardiac Muscle Disease: Cardiac Arrhythmias

A

-abnormal rate of contractions
-can cause sudden cardiac arrest from SA node
-can lead to decreased CO

-Sick Sinus node syndrome
-Suprasventricular tachycardia
-V fib

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86
Q

Causes of Cardiac Muscle Disease: Renal Insufficiency

A

-contributes to CMD due to increased fluid triggered by low BP or low BV
-RAAS
-maintains Na and K balance

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87
Q

Causes of Cardiac Muscle Disease: Cardiomyopathy

A

-disease of heart muscle leading to heart failure
-impaired contractility
-HTN, MI, metabolic disorders, heart valve issues

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88
Q

Causes of Cardiac Muscle Disease: Dilated Cardiomyopathy

A

Heart failure with reduced ejection fraction (<40)

-systolic dysfunction: less effective pump, decrease CO, fluid back up
-increased LV EDV
-lead to electrical issues

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89
Q

Causes of Cardiac Muscle Disease: Hypertrophic Cardiomyopathy

A

-enlarged heart that cannot relax
-Heart failure with preserved EF
-diastolic dysfunction: less compliant
-increases left EDP
-rapid ventricular emptying
-muscle cells disorganized

-common cause for sudden cardiac arrest in young athletes

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90
Q

Causes of Cardiac Muscle Disease: Restrictive Cardiomyopathy

A

-cannot relax
-EF preserved
-diastolic dysfunction; decreased filling
-scar tissue in myocardium (sarcoidosis/radiation) OR defect in myocardial relaxation
-hypertrophy

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91
Q

Pulmonary Embolism

A

-lung infarction due to decreased BV
-increased pulmonary hypertension
-increases load to right side of heart
-presence of ascities, bilateral LE edema and jugular vein distension
-increases V/Q ratio

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92
Q

Pulmonary Hypertension

A

-risk for cardiac disease
->20mmHg
-increased R ventricle work (Swangan’s Catheter)

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93
Q

Congestive Heart Failure

A

-decreased CO
-LV failure
-increased BNP (stretch protein in heart)
-attempts compensatory strategies (sympathetic, RAAS, heart receptors, EPO)

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94
Q

Rate Pressure Product

A

-SBP*HR
-exercise threshold
-myocardial o2 demand
->10,000 @ rest, increase risk of angina

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95
Q

S1

A

-first heart sound (higher frequency)
-closure of M1 and T1
-best heard in Mitral Area

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96
Q

S2

A

-second heart sound (lower frequency)
-closure of semilunar valves valves
-best heard in Aortic Area

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97
Q

S3

A

-dilated/large ventricle causes rapid flling causes loud sound
-systolic issue
-could be abnormal (heart failure, dilated cardiomyopathy, late diastole) or normal (pregnancy/children, athletes)
-extra heart sound after S2
-“kenTUCKy”
-listen with bell @ apex

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98
Q

S4

A

-rigid ventricle decreases filling, atria contract late to push past force
-diastole issue
-always abnormal (HTN, MI, atrial kick of blood into stiff ventricle diastolic bad)
-right before S1
-gallop

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99
Q

RV Failure S/S

A

-venous insufficiency, edema, weightt gain, liver issues

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100
Q

LV Failure S/S

A

-pulmonary issues, effusion, S3, crackles, decreased O2, paleness, increased HR, increased Breathing

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101
Q

Arrhythmias (Medications)

A

-inhibit abnormal impulses by affectting membrane permeabiliy to specific ions (Cl, K, Ca, Na)
-SA & AV node
-prelong refractory period

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102
Q

Hypertension (Medications)

A

-reduce fluid, limit SNS, decrease RAAS

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103
Q

Beta Blockers

A

-olol
-reduced beta receptor binding
-selective of nonselective

B1: increases HR and contractility
B2: bronchoconstriction and vasodilation

CI
-HTN, ischemic HD, heart failure, arrhythmias

SE
-sedation, may mask hypoglycemia, reduced thermoregulatry response, spasms, orthostatic hypotension

Max HR: 164 - (.7 x age)

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104
Q

Orthostatic Hypotension

A

decreased of BP 20 and HR increase of 30 when standing from sitting

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105
Q

Calcium Channel Blockers

A

-pine
-decrease HR & BP, conrtactility, O2 demand
-cause vasodilaiton of coronary artieries

CI
-reduce re-infarctions (dead tissue releases Ca), ischemic HD, heart failure, arrhythmias

SE
-negative inotropic effects, blunted HR responses to exercise

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106
Q

Nitrates

A

-nitr
-slows HR, reduce preload and afterload, decrease contrtactility, lower BP, vasodilation

CI
-HTN, ischemic HD, heart failure, angina

SE
-hypotension, dizziness, reflex tachycardia, skin flushing

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107
Q

Angina (Medications)

A

-chest pain due to ischemia
-lack of O2 stimulates pain receptors

-treated by nitrates, BB, CC blockers
S/s
-tightness and chest pain
-simular to MI
-ECG ST downward shift

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108
Q

Thrombolyic Agents

A

-break clots up quickly
-goal to keep ischemic time <120min

SE
-arrhythmias due to rapid reperfusion (high K, reflex tachycardia), bleeding, hemorrhage CVA

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109
Q

Anti-Platelet Agents

A

-prevent platelet aggregation and thrombus formation
-decrease platele adverance to site of injury

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110
Q

Anticoagulants

A

-prevention of blood clots, inhibit thrombin

Common: heparin, pradaxa, xarelto, eliquis

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111
Q

Diuretics

A

-ide
-decrease blood volume by peeing
-improve cardiac contractility
-reduce cardiac demand
-act of kidneys (loop of henle most potent)

CI
-HTN, heart failure

SE
-hypotension, arrhyhmias (K+)

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112
Q

ACE Inhibitor

A

-pril
-prevents conversion of ang 1 to 2

SE
-hypotension, dizziness, angioedema (life thrreatening tongue swelling), hyperkalemia

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113
Q

Angiotensin Receptor Blockers (ARBs)

A

-sartan
-limits effects of ang 2

SE
-hypotension, dizziness, angioedema (life thrreatening tongue swelling), hyperkalemia

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114
Q

Cardiac Glycosides

A

-positive inotropes
-increase Ca+
-decrease HR
-increase delay from SA to AV
-increase PR interval
-anti arrhythmics

ex: digoxin

CI
-dilated cardiomyopathy
-a fib
NOT FOR 2nd or 3rd Heart Blocks

SE
-lots of symptoms of digitalis toxicity

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115
Q

Sympathomimetics

A

-positive inotropes
-mimic SNS, treat shock, heart failure
-short term use only to prevent downrreg

CI
-parenteral use for hheart failure

116
Q

Phosphodiesterase Inhibitors

A

-positive inotropes

CI
-severe CHF, strengthen contractions

117
Q

Vasodilators

A

-decrease bv, vascular resistance
-Arterial: reduce afterload
-Venous: reduce preload

CI
-HTN, HF, ischemic heart disease

SE
-compensatory SNS actitvation

118
Q

Critical Illness Polyneuropathy

A

-sensory and motor nerves involved
-main contributor to persistent disability
-sepsis and organ failure
-chronic denervation

119
Q

Critical Illness Myopathy

A

-diffuse flaccid weakness in all limbs
-can have complete recovery
-chronic denervation
-can be caused by steroid use

120
Q

PEEP

A

-Positive End Expiratory Pressure
-resisdual pressure in alveoli after exhalation
-pressure required to inflate alveoli and prevent collapse

Low PEEP 3-5: normal
Moderate PEEP 5-15: treat refractory hypoxemia
High PEEP >15: severe lung injury
-put pressure on IVC and decreased CO

121
Q

Mode of Ventilation

A

-how breath is delivered

  1. Assist-Control
  2. SIMV and Pressure Support
  3. Pressure Support
122
Q

Assist-Control

A

-non weaning: breathing for patient
-rate and tidal volume pre-set
-patient can trigger breaths with pre-set tidal volume

123
Q

SIMV

A

-synchronized intermittent Mandatory Ventilation
-Weaning mode: starting to take them off
-rate and tidal volume pre-set
-patient can trigger breaths with pressure support instead of pre-set tidal volume

124
Q

Pressure Support Ventilation

A

-weaning mode: 0-30cmH20 (10 normal)
-applies to spontaneous breaths
-tidal volume not pre-set
-NOT air, only pressure

125
Q

CPAP

A

-constant positive pressure applied in airways
-noninvasive ventilation

126
Q

BIPAP

A

-Bi-level pulmonary airway pressure
-noninvasive ventilation

127
Q

SaO2

A

-actual o2 content in blood

128
Q

SpO2

A

-estimated o2 content in blood
-<88 is concerning, drop in hemoglobin curve

SE
-syncope, dizziness, paleness, quick breathing (>30bpm at rest)

129
Q

Lead I

A

-limb lead
Right arm to Left arm
-normal wave form

-Circumflex A.
-lat wall of LV

130
Q

Lead II

A

-limb lead
Right arm to lower limb
-normal wave form

-Right Coronary A.
-Inferior portion of heart/apex

131
Q

Lead III

A

-limb lead
-leftt arm to lower limb
-normal wave form (may have inverted P and t wave)

-Right Coronary Artery
-Inferior portion of heart/apex

132
Q

aVF Lead

A

-augmented lead
Middle of body to lower limb

-Right coronary Artery
-Inferior portion of heart/apex
-normal wave form

133
Q

aVL Lead

A

-augmented lead
From middle to Left arm

-Circumflex A.
-lat wall of LV
-normal wave form

134
Q

aVR Lead

A

-augmented lead
From middle of body to right arm

-Top of RV
-inverted wave form

135
Q

V1

A

On Right 4th intercostal space
-septal, precordial lead
-L Ant. Descending A.

-inverted P-wave, deep S
-RV

136
Q

V2

A

On Left 4th intercostal space
-septal, precordial lead
-L Ant. Descending A.

-inverted P-wave, deep s
-RV, septum

137
Q

V3

A

On left between 2 and 4
-Anterior Heart, precordial lead

-Right coronary A.
-RV, septum, ant. heart

138
Q

V4

A

On left 5th intercostal space mid clavicular line
-Anterior Heart, precordial lead

-Larger R, small s
-Right coronary A., ant heart

139
Q

V5

A

On left 5th intercostal space anterior axillary line
-Lateral heart, precordial lead

-Larger R, small s
-Circumflex A., lat wall of heart

140
Q

V6

A

On left 5th intercostal space mid axillary line
-Lateral heart, precordial lead

-Larger R, small s
-Circumflex A., lat wall of heart

141
Q

Premature Ventricular Contraction

A

-random cell in ventricles fire out of sync of the rest, prematurely
-wide QRS

142
Q

Ventricular Bigeminy

A

-PVCs occur every 2 beats

143
Q

Ventricular Trigeminy

A

-PVCs occur every 3 beats

144
Q

Ventricular Couplet

A

-PVCs occur in 2s

145
Q

Ventricular Triplet

A

-PVCs occurr in 3s
-non sustained ventricular tachycardia
-STOP and check vitals

146
Q

Ventricular Tachycardia

A

-fast/large/wide QRS with no p wave, regular
-emergency

147
Q

Supraventricular Tachycardia

A

-fast/narrow QRS
-comes from atria not SA node

148
Q

Junctional Rhythm

A

-slow (40bpm) /no p wave/inverted T wave
-originates away from atria but depolarizes ventricles

149
Q

ST Elevation

A

-Acute MI
-Stimi

150
Q

ST Depression

A

-Angina/ischemia/infarction

151
Q

P Wave Inversion

A

-Heart block with junctional rhythm

152
Q

T Wave Inversion

A

-MI or ischemia
-BBB
-hypertrophy
-pulmonary embolism

153
Q

Ventricular Fibrilation

A

-dangerous, call code
-irregular/fast/small

154
Q

Atrial Fibrilation

A

-chaos/irregular
-QRS present, no p wave
-multiple cells firing

-valve issues, ischemia, stroke, arrhythmia

155
Q

Atrial Flutter

A

-saw tooth/bread knife
-1 cell going crazy
-QRS present and irregular

156
Q

Torsades De Pointes

A

-V tach with prolonged QT, irregular
-Looks crazy…how are you alive

157
Q

Right Bundle Branch Block

A

-delayed depolarization of RV
-right lead (V1): “M” in QR, deep S
-Left lead (V6): “W” in S wave

158
Q

Left Bundle Branch Block

A

-delayed depolarization of LV
-right lead (V1): “W” in R wave
-Left lead (V6): “M” in R wave

-anomally always at tip of QRS

159
Q

1st Degree AV Block

A

-husband is late but comes home, long PR interval
-from SA node
-slow HR

160
Q

2nd Degree AV Block : Type 1

A

-husband is later and later and then doesn’t come home
-longer PR interval then dropped QRS
-AV node

161
Q

2nd Degree AV Block : Type 2

A

-husband randomly doesn’t come home
-normal PR intervals
-randomly dropped QRS
-Bundle of his

-DONT WORK WITHOUT PACEMAKER

162
Q

3rd Degree AV Block

A

-normal p wave unrelated to QRS, no correlation of QRS
-random p waves

-DONT WORK WITHOUT PACEMAKER

163
Q

Angioplasty

A

-balloon inflated to push plaque against lumen
-stent then put in
-prone to bleeding
-5-7days no exercise

164
Q

Arthrectomy

A

-larger plaque buildup, cut out the plaque

165
Q

Coronary Artery Bypass Graft

A

-CABG
-open heart surgery
-place another vessel from one spot to bypass blockage (radial arteries, saphenous veins, mammary arteries)

166
Q

Sternal Precautions

A

-limit movement for 6-8 weeks
-gentle coughing
-move “in the tube”: keep arms to the side
-infection control

167
Q

Intraortic Balloon Pump

A

-severe heart failure; shock
-restore CO
-inserted in femoral (bedrest) and axillary (might be allowed to exercise) to ascending aorta
-balloon inflates and deflates to increase CO by 40%

168
Q

Anesthesia

A

-restrictive
-depresses breathing and diaphram contractions (intubation)
-decreases TLC, FRC, RV, lung compliance
-can cause collapse, shunting, atelectasis
-consider time under and O2 given during procedure
-airway obstructions from tubes/fluids

FRC
-causes alveolar collapse in supine

169
Q

Bed Rest Effects

A

Cardio:
-increased resting HR, risk of DVT
-decreased max HR, Vo2max

Respiratory:
-decreased vital capacity, inpaire toilet, increase V/Q mismatch

170
Q

Abnormal Response to Exercise

A

-HR increase 20-30 or drop below resting
-SBP increase 20-30 or drop by 10
-Spo2 drop
-High RR, accessory muscles

171
Q

ECMO

A

-Veno-Arterial Ecmo: supports heart and lungs

-Veno-venous Ecmo: supports lungs

-cannot be turned off by PT

172
Q

LVAD

A

-Left ventricular assist device
-pump blood from LV to aorta
-has outer controller
-3-10L/m (drop in flow could be pump failure)
-Speed usually fixed (abnormal condition)
-10 Watts
-Pump Index (higher is better LV function

Complications:
-bleeding, infection, MAP

173
Q

Heart Transplant

A

Indications:
-CHF, Cardiomyopathy, low prognosis

Post op:
-infections, low response to activity, sternal precautions

Denervated heart:
-no ischemic pain
-higher RHR >90
-slower HR changes
-orthostatic HTN

174
Q

Lung Transplant

A

Single:
-Thoracotomy
Double:
-clamshell

Complications:
-pneumothorax, plural effusion, hypoventilation, phrenic n injury

Denervated Lungs:
-decreased cough reflex, ciliary mmt
-Increased infection risk, edema, mucous

175
Q

Emphysema

A

-COPD
-Obstructive
-red skin, skinny, pursed lips
-working hard to exhale air, can still oxygenate
-hypercompliant lung balloons alveoli trapping air

-O2 desaturation during exercise

Panacinar: alveoli only, genetic
Centrilobular: bronchioles only, progression of bronchitis

176
Q

Chronic Bronchitis

A

-COPD
-obstructive
-inflamation of bronchioles obstructing/narrowing airway and increasing mucous/cough
-“blue bloater”

S/S:
-Cor pulmonale, jugular vein distension, edema, decreased FEV1

177
Q

Hypercapnic

A

-increased Co2
-hypoventilation: increases Co2, lowers pH
>45 PaCo2

178
Q

Hypoxemia

A

-decreased blood o2
<80% PaO2

179
Q

Hypercompliant Lung

A

-stretches excessively without returning to normal during exhalation
-increased FRC, PaCo2, airway resistance
-Decreased PaO2, intrathoracic pressure

-COPD, Obstructive

180
Q

Hypocompliant Lung

A

-does not expand or contrac correctly
-decreased VC and RV
-increased work and pressure
-restrictive, obesity, surgery

181
Q

Tidal Volume

A

-500ml
-amount of air moved in and out in each breath

182
Q

Inspiratory Reserve Volume

A

-3000ml
-max inspiration after normal inspiration

-decrease with restrictive

183
Q

Expiratory Reserve Volume

A

-1100ml
-max one can expire after normal exhale

184
Q

Residual Volume

A

-1200ml
-volume of air left in lungs after max exhale
-FRC-ERV=RV (cannot be measured)

185
Q

Functional Residual Capacity

A

-volume of air in lungs after normal expiration
-RV + ERV
(cannot be measured)
-balances lung and chest wall forces

186
Q

Inspiratory Capacity

A

-max volume one can inspire
-TV+ IRV

-decrease with restrictive

187
Q

Vital Capacity

A

-max volume one can exchange in a respiratory cycle
-IRV+TV+ERV

-decrease with restrictive

188
Q

Total Lung Capacity

A

-air in lungs during full inflation
-IRV+TV+ERV+RV
-RV+VC=TLC
(cannot be measured)

-decrease with restrictive, increase obstructive

189
Q

FEV1

A

-forced expiratory volume in 1 sec
-80% of predicted/max
-based on age, gender, race, height

190
Q

FVC

A

-forced vital capacity
-how much can you force out and in

191
Q

FEV1/FVC

A

-percentage of vital capacity exhaled in 1 sec
->70% norm

192
Q

pH

A

-<7.4 acidic
->7.5 alkaline

7.35-7.45

193
Q

Hgb

A

-hemoglobin (12-16)

194
Q

Acid Base Regulation

A

-kidneys can extrete or retain HCO3 (slowly)

Increased Ecretion: low pH, metabolic acidosis
Decreased Extrcetion/Increased Retention: high pH, metabolic alkalosis

-respiratory
Hyperventilation: raises pH, reduces Co2, respiratory alkalosis
Hypoventilation: increases Co2, lowers pH, respiratory acidosis

195
Q

Respiratory Acidosis

A

-excess CO2, low pH

Causes:
-CNS depression
-ashyxia/hypoventilation

Compensation:
-high HCO3-

S/S:
-sweating, headache, tacycardia, restlessness

196
Q

Respiratory Alkalosis

A

-low CO2 (excretion), high pH

Causes:
-hyperventilation
-respiratory stimulation
-bacteria

Comensation:
-low HCO3-

S/S:
-rapid breathing, parasthesia, light headedness, twitching

197
Q

Metabolic Alkalosis

A

-HCO3- retention (acid loss), high pH

Causes:
-renal disease
-vomiting
-decreased K

Compensation:
-high CO2

S/s:
-shallow breathing, confusion, twitching, restlessness

198
Q

Metabolic Acidosis

A

-HCO3- loss (excretion), low pH

Causes:
-kidney disease
-hepatic disease
-endocrine disorders
-high K

Compensation:
-low CO2

S/s:
-rapid breathing (kuzmals), fatigue, fruity breath, headache

199
Q

Evaluate ABG Results

A
  1. pH
    -high= alkalosis
    -Low= acidosis
  2. CO2
    -high: resp acidosis (with low pH)
    -low: res alkalosis (with high pH)
  3. HCO3
    -high: metabolic alkalosis (with high pH)
    -low: metabolic acidosis (with low pH)
  4. Compensatory
200
Q

ABG Short Cut

A

Metabolic: look @ pH and HCO3- same (look at co2 for compensations-must be same)

Respiratory: look @ pH and CO2-different (look at HCO3 for compensations-must be same as CO2)

201
Q

Obstructive Disorders

A

-airway obstruction, reduce flow rates
-asthma, COPD, cystic fibrosis
-FEV1/FVC= <70%

202
Q

Restrictive Disorders

A

-reduction in vital capacity
-pulmonary or neuro

Acute:
-atelectasis, pneumothorax, pneumonias, respiratory distress syndrome, Pleural effusion, ascities, LVAD

Chronic:
-BPD, pulmonary fibrosis, SLE, scleroderma, cancer, skeletal issues, neuromuscular issues

203
Q

Adventitious Sounds

A

-Crackles or rales: discontinuous sounds; airway obstruction or restrictive lung diseases

-wheezing: smaller airways, asthma

-stridor: crowing sound, uper airway obstruction

-Pleural rub: rubbing inflamed pleural surfaces agains lung

204
Q

Diagnosis of Sounds

A

Pleural Effusion: conta traacheal dev, decreased sounds, dull percussion (stuff)

Consolidation: increased fremitus and pectoriloquy, decreased breath sounds, dull percussion, bronchial sounds

Emphysema: decreased fremitus, hyper resonant percussion, decreased pectoriloquy, crackles

Tension Pneumonthorax:
-contra tracheal dev, hyper resonant percussion, decreased breath sounds

Mucus Plug w/ Collapse: ipsi tracheal dev, decreased everything, dull percussion

205
Q

Medicare

A

-65+ or disability
Part A: IP, SNF, HH, Hospice
Part B: OP, DME

206
Q

Medicaid

A

-low income, pregnant, responsible for minor, disabilities

207
Q

Discharge Planning: Independent Living

A

-walk 400m (different terrains, obstacles)
-1.2 m/s gait
-carry 1 gallon/8lbs

208
Q

Discharge Planning: Inpatient

A

-3 hrs per day of therapy
-high level of prior function
-not safe to go home

209
Q

Discharge Planning: Skilled nursing facility (SNF)

A

-unable to do 3 hrs a day
-variable prior function
-moderate progress

210
Q

Discharge Planning: Outpatient

A

-high level of function
-stable needs
-community travel

211
Q

Discharge Planning: Home health

A

-limited ambulation
-safe at home
-good functional prognosis

212
Q

Discharge Planning: Long term acute care

A

-high complexity
-poor prognosis
-less need for skilled therapy

213
Q

Discharge Planning: palliative care

A

-chronic illness
-treat pain and suffering
-fix things other than physical

214
Q

Discharge Planning: Hospice

A

-end of life care
-6 months or less
-manage pain and symptoms

215
Q

Discharge Planning: Advanced Care Directives

A

-identify preferences for care

Living wills, DNR, medical orders for life sustaining care, power of attorney

216
Q

Injury Descriptions: Aching

A

Muscular

217
Q

Injury Descriptions: Burning

A

Muscular or neural

218
Q

Injury Descriptions: Shooting, lightning, electrical

A

Nerve root irritation

219
Q

Injury Descriptions: Coldness

A

Blood flow issues

220
Q

Injury Descriptions: Hotness

A

inflammation or infection

221
Q

Injury Descriptions: Clicking, snapping, popping

A

ligament or tendon dysfunction

222
Q

Injury Descriptions: Joint locking

A

Cartilage tear, looseness, misalignment

223
Q

Injury Descriptions: Global weakness or fatigue

A

Cardio or pulmonary dysfunction

224
Q

Injury Descriptions: Whole body pain

A

-central somatization: chronic pain

225
Q

Red Flags Requiring Immediate Attention

A

-anginal pain no relieved in 10-20min
-angina with sweating, nausea, vomiting
-Diabetic client that is confused or lethargic
-onset of incontinence or saddle anesthesia
-anaphylactic shock

226
Q

BATTED

A

-ADLS: activities of daily living
-Bathing
-Ambulation
-Toileting
-Transfers
-Eating
-Dressing

227
Q

Ataxia

A

-lack of control of body movements

228
Q

Dysmetria

A

-error in trajectory
-inability to touch target

229
Q

Anesthesia

A

-complete loss of sensation

230
Q

Hypoesthesia

A

-abnormally low sensitivity to sensation

231
Q

Hyperesthesia

A

-abnormally high sensitivity to sensation

232
Q

Hypalgesia

A

-diminished sensitivity to pain

233
Q

Graphesthesia

A

-recognizing writing on skin

234
Q

Hyperalgesia

A

-incrreased sensitivity to pain

235
Q

Astereognosis

A

-inability to recognize familiar object by touch

236
Q

Atopognosis

A

-inability to corrrectly locate sensation

237
Q

Abaragnosis

A

-inability to distuingiush different weights

238
Q

Paresthesia

A

-Abnormal sensation

239
Q

Dysethesia

A

-impairment of any sensation

240
Q

Paralysis

A

-loss of motor function

241
Q

Hemiparaplegia

A

-paralysis of lover half of one side of body

242
Q

Hemiparesis

A

-muscular weakness or partial paralysis on one side

243
Q

Hemiparaesthesia

A

-pertaining to hemiparesis

244
Q

Hemiplegia

A

-paralysis on one side of body

245
Q

Paraparesis

A

-partial paralysis of LEs

246
Q

Paraplegia

A

-paralysis of LEs

247
Q

Tetraplegia

A

-paralysis of all extremities

248
Q

Quadriplegia

A

-paralysis of all extremities

249
Q

Triplegia

A

-paralysis of 3 extremities

250
Q

Diplegia

A

-paralysis of either both UEs or LEs

251
Q

AROM

A

-muscle strenth, coordination, willingness to move
-contractile tissue integrity
-if they can do AROM, no need for PROM

252
Q

PROM

A

-integrity of joints, extensibility of CT, endfeels of joints
-diagnostic
-slightly > AROM

253
Q

Injury Severity

A

Strong & Painless: intact
Strong & Painful: minor
Weak & Painful: Major
Weak & Painless: complete lesion or neuro deficit

254
Q

Testing Order For Class

A
  1. Dermatome
  2. Periperal N.
  3. Opposite Tracts
  4. Myotome
  5. Reflexes
  6. ROM Screen
  7. ROM Testing
  8. MMT
  9. Outcome Measure
255
Q

Most Common Areas of Spine for Disc Pathology

A

-C6-C7
-L4-L5
-L5-S1

256
Q

Cervical AROM Values

A

Flx: 40
Ex: 50-70
LSB: 22
Rot: 70-90

257
Q

Thoracolumbar AROM Values

A

Flx: 60
Ex: 25
LSB: 35
Rot: 45

258
Q

Lumbar AROM Values

A

Flx: 40-50
Ex: 15-20
LSB: 25

259
Q

Shoulder ROM Values

A

Flexion: 180
Extension: 50-60
Abd: 180
Internal Rot: 70-80
External Rot: 90

260
Q

Elbow ROM Values

A

Flexion: 140-150
Extension: 0
Supination: 80
Pronation: 80

261
Q

Wrist ROM Values

A

Flexion: 80
Extension: 70
Rad Dev: 20
Ulnar Dev: 30

262
Q

Finger ROM Values

A

-MCP:
Flex/ext: 90/45

-PIP:
-Flx/Ext: 100/0

-DIP:
-Flx/Ext: 90/0

263
Q

Gait Cycle

A

Stance:
-Initial contact (Preswing): heel contact, flexion hip (20)

-Loading response (initial swing): weightshift, flexed knee (15), DF (7 lack of will show)

-Midstance (Middle Swing): Neutral hip

-Terminal Stance (Terminal Swing): extended hip (20 backwards rotation of pelvis will show it flexors are tight), DF (10 at highest)

-Pre-Swing (Initial contact): full extension, flexion (40), PF (15 need toe extension for windlass)

Swing:
-Initial Swing (loading response): toe off, most knee flexion (60), pelvis rotates to catch up

-Middle Swing (Midstance): most flexion (25)

-Terminal Swing (Terminal Swimg): right before initial contact

264
Q

Hemiplegic Gaitt

A

-one side of body is weak
-cerebral palsy, tbi, stroke

265
Q

Antalgic Gait

A

-short stance on pain side

266
Q

Ataxic Gait

A

-lack of coordination

267
Q

Scissor Gait

A

-crossing over
-tightness of hib adductors
-cerebral palsy

268
Q

Parkinsonian Gait

A

-shuffling feet with flexion placing weight on balls of feet

269
Q

Steppage Gait

A

-excessive hip and knee flexion to clear limb

270
Q

Vaulting Gait

A

-rapid ankle PF to clear limb

271
Q

Plumb Line

A

-ant to mastoid
-anterior acromion
-post to hip
-anterior to knee
-anterior to malleolus

272
Q

Anterior Pelvic Tilt

A

-tight errectors and hip flexors
-weak glutes and abs

273
Q

Posterior Pelvic Tilt

A

-weak errectors and hip flexors
-tight glutes and abs

274
Q

Coxa Valga

A

-greater angle of inclination >125
-straighter
-longer limb
-increase dislocation
-genu varum

275
Q

Coxa Varum

A

-lesser angle of inclination <125
-shorter limb
-improved congruence
-more stress on neck
-genu valgum

276
Q

Anteversion

A

-greater torsion than normal >20
-head more anterior
-more IR, toe in

277
Q

Retroversion

A

-lesser torsion than normal <10
-head more posterior
-more ER, toe out

278
Q

Deep Tendon Reflex Grades

A

No reflex: 0
Minimal Response: 1+
Normal: 2+
Overly Brisk: 3+
Extremely brisk; cross over reaction: 4+

279
Q

Biceps Tendon

A

C5
-Elbow flexion

280
Q

Brachioradialis Tendon

A

C6
-elbow flexion

281
Q

Triceps Tendon

A

C7
-elbow extension

282
Q

Patellar Tendon

A

L4
-knee extension

283
Q

Achilles Tendon

A

S1
-plantarflexion

284
Q

International classification of functioning disability in Health (ICF)

A

Body structures and functions, activities, participation, environment, personal factors, and health conditions

285
Q

Controlled substances

A

Schedule one: highest abuse, potential and illegal (heroin).
Schedule two: approved for therapeutic purposes, with high potential for abuse (morphine)
Schedule three: mild dependence (steroids.)
Schedule 4: low abuse, potential (antianxiety drugs)
Schedule five: lowest abuse, potential (cough meds)

286
Q

Steps of inflammatory response

A
  1. Vasodilation
  2. Increased capillary permeability
  3. Loss of fluid.
  4. Blood clotting.
  5. Migration of leukocytes.
287
Q

Bone tissue repair

A
  1. Inflammatory phase (two weeks), hematoma forms, and initiates Fibrin
  2. Repairative phase(6 to 12 weeks): granulation tissue in fibrocartilage forms a soft Calus
  3. Endochondral ossification (months to years): soft calluses, replaced by bony callus.
288
Q

Tendon healing

A
  1. Proliferation of tenoblasts
    from cut ends
  2. Vascular in growth and proliferation of fibroblasts.
    - Inflammation begins 3 to 5 days after injury and proliferative phase last 2 to 3 weeks.
    -Collagen orients into thick bundles and at three weeks type three collagen is replaced by type one

Neuromuscular (21 decks)

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