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General Medical Rehab Flashcards

1
Q 
Total Lung Capacity
Vital Capacity 
Forced Vital capacity
FEV1
Residual volume
Minute voume
A

TLC: Total amount of air in lungs after max inspiration
VC: The amount of air that can be expelled after a deep breath
FVC: same as above but after maximal exhalation
FEV1: amount exhaled in first second (decreases over time, way faster in smoker)
RV: amount of air in lungs at end of large exhalation
MV: Amount of air inhaled/exhaled in 1 min

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2
Q

Pulmonary rehab

A

increases AVO2 difference

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3
Q

Most common brain tumor

Cerebellar astrocytomas the most common CNS tumor in young adults, over the age of 7.

A

astrocytoma (glibolastoma)

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4
Q

Most common metastatic

A

lugng, breast, GI

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5
Q

Most common brain tumor in children

A

Cerebellar astroyctoma (better prognosis), medulloslbastoma

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6
Q

most common primary osseous tumor

A

osteosarcoma (knee-sital femur, proximal tibia)

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7
Q

Most common metastatic cancers to bone

A

lung, breast, prostate, MM (prostate is the oosteoblastic one best seen with bone scan)

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8
Q

Most common pediatric cancer

A

Leukemia

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9
Q

most common solid pediatric cancer

A

Brain tumors- pilocytic astrocytoma, medulloblastoma, ependymoma (posterior fossa tumors)

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10
Q

Pediatric burn percents

A

18% head, 14% each limb, every year after 1 subtract 1% from the head and add 0.5% to each leg

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11
Q

Pts who benefit most from pulm rehab

A
  • resp limitation of exercise 75% of predicted max O2 consumption
  • Obstructive airway disease with FEV1 <2,000mL or FEV1/FVC ratio <60%
  • Restrictive lung disease with CO diffusion capacity <80% of predictive value
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12
Q

Pulmonary disability Moser Classification (stages 1-4 do not have dyspnea at rest)

A

1) normal at rest, dyspnea with strenuous exercise
2) Normal ADL performance- dyspnea on stairs/incline
3) Dyspnea with some ADLs; able to walk 1 block slow pace
4) Dependent with some ADLs; dyspnea with minimal exertion
5) Dyspnea at rest, housebound

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13
Q

Vo2 max equation

A

VO2 max= (HR x SV) x AVO2 difference

VO2 depends on body weight , age, sex, genetics (most important).

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14
Q

Obstructive disease

A

Air trapping, low max mid-expiratory flow rate, and normal to increased compliance, increased total and residual lung volumes

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15
Q

Chronic bronchitis
Emphysema
Cystic Fibrosis
Asthma

A

Chronic bronchitis- tracheobronchial mucous gland enlargement
Emphysema- distention of terminal nonrespiratory bronchioles with destruction of alveolar walls (secondary to neutrophil derived elastase); destruction of alveolar wall elasticity results in loss of lung recoil leading to excessive airway collapse on exhalation and chronic air obstruction/trapping.
CF: AR Cl- ion channels, failure to remove secretions from bronchioles, causing obstruction, bronchiectasis, overinflation and infection, aerobic exercise
Asthma- hypertrophy of bronchial muscle, mucosal edema, infiltration of eosinophils and mononuclear cells. Chronic bronchitis can result from asthma

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16
Q

FEV in COPD patients

A

FEV1 of 4L, no exercise impairment
FEV1 2-3 L, mild exercise limitation
FEV1 1-2 L moderate exercise impairment
FEV1 <1 L severe exercise impairment

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17
Q

Restrictive Lung Disease Intrinsic vs extrinsic

A

Intrinsic- asbestosis, sarcoidosis, silcosis, idiopathic pulmonary fibrosis
Extrinsic: NM dz, Thoracic deformities (>90 deg of scoliosis then have dyspnea, >120 deg scoliosis hypoventilation/cor pulmonale), Pleural dz, AS, Cervical SCI, obesity, surgical removal of lung tissue

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18
Q

DMD lung

A

resp muscle weakness -> Hypoventilation-

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19
Q

Chronic alveolar hypoventilation with hypoxemia

A

Reduced arterial oxygen tension (PaO2) and increased Carbon diooxide tension (PaC02) leading to daytime sleepiness.

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20
Q

ALS lung

A

Measure FVC at diagnosis and then every 3 months to monitor disease progression (FVC best prognostic indicator)
Earliest changes are decr in max inspir/expir muscle pressures, followed by reduced VC and maximum breathing capacity,

A vital capacity less than 25 ml/kg would have an impaired ability to cough

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21
Q

Active expiration

A

Abdominal muscles, internal intercostals

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22
Q

Aging PFTs

Restrictive Lung PFTs

Obstructive Lung PFTs

A

Aging:
Decrease: VC, FEV1 (30 mL/year), PO2, MVV
Increase: RV, FRC
No changes in : TLC, PCO2

Restrictive:
Decrease: VC, TLC, RV, FRC, FVC, MVV
FEV1 IS NORMAL!!!!

Obstructive:
Decrease: VC, FEV1 (45-75 mL/year) , FVC, MVV
Increase: RV, FRC, TLC

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23
Q

Ventilatory support for DMD

A

No clear guidelines but : dyspnea at rest, 45% of predicted VC, max inspiratory pressure <30% predicted, hypercapnia

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24
Q

Young pts with moderate asthma who have tried B2 agonists during exercise as well as mast cell stabilizers or LT inhibitors may benefit from

A

Theophylline for exercise induced asthma/bronchospasm

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25
Inheritance pattern of CF
Autosomal Recessive- involving Chloride ion channels found in exocrine glands. Failure to remove secretions- obstruction, bronchiectasis, overinflation and infection
26
Therapy for CF
Aerobic exercise helps increase sputum production, increase ciliary beat
27
Asthma
Hypertrophy of bronchial muscle , mucosal edema, infiltration with eosinophils and mononuclear cells which causes changes in the basement membrane.
28
SCI respiratory dysfunction related to 3 factors
1) Reduced VC 2) Retention of secretions 3) Autonomic dysfunction
29
Complete lesions above C2 result in loss of function of
Diaphragm and intercostal muscles
30
What increases in C spine injury
residual volume
31
PFT of C5 injury
Expiratory muscles paralyzed- retain 60% of inspiratory capacity and ventilate well, but have weak cough and difficulty clearing secretions during respiratory infections; All volumes are greatly reduced because of limited expansion of chest wall; decr TLC and VC, incr RV
32
Nutrition status COPD
- decr serum albumin levels, supplement with 1.7 g/kg body weight per day - Pseudomonas colonize poor nutrition ppl - Affects surfactant synthesis - Incr fluid intake in COPD
33
Supplental oxygen
reduce polycythemia, improve pHTN, prolongs life expectancy, improved cognition, decr blood pressure
34
Controlled breathing techniques
Used to reduce dyspnea, reduce work of breathing, and improve respiratory muscle function and pulm function
35
Diaphragmatic breathing
Used to reverse altered pattern of resp muscle recruitment; hand under thorax and on abdomen and try too expand abdomen; benefits : increased tV, decr FRC, increase in Max O2 uptake
36
Techniques to reduce dyspnea and work of breathing
Pursed lips
37
Airway secretion mgmt techniques
Controlled cough, Huffing pg 660
38
Electrolyte impairment in acute DMD respiratory exacerbation
Hypokalemia
39
Uses of glossopharyngeal breathing
Pt can breathe without mechanical ventilation
40
Intermittent abdominal pressure ventilator
air sac inflates and compresses abdomen causing diaphragm to move up and assist with expiration
41
Speaking valve for patient who only requires intermittent ventilatory assistance
Fenestrated tubes
42
Speaking valve for patient who requires continuous mechanical ventilation
Non fenestrated tube, open on inhalation and close on exhalation for phonation
43
Talking tracheostomy tube
used in alert and motivated patients, when thumb port is occluded, gas passes through larynx via small holes above the inflated cuff allowing patient to speak
44
Passy-Muir valve
unique in that it is the only valve that is maintained in closed position and opens only on inspiration, other valves are open at all times until they are actively closed during expiration; contraindication vocal cord paralysis, inflated cuff, tracheal stenosis
45
Cardiac rehab phases
I : during acute hospitalization (1-14 days) intensity should be aimed at 4 mets by the end of phase 1. II: Closely supervised lasting 3-6 months III: Extended outpatient period divided into intermediate and maintenance
46
VO2
represents oxygen consumption of the whole body and corresponds to peripheral skeletal muscles (rather than myocardial)
47
Maximum oxygen consumption that an individual can achieve during exercise
VO2 max which is = COxAVO2 difference
48
Myocardial oxygen consumption
actual oxygen consumption of the heart measured via cath
49
Can be used to estimate MVO2 (MVO2 surrogate)
Rate pressure product: SBPXHR
50
Can be used to estimate MVO2 (MVO2 surrogate)
Rate pressure product: SBPXHR divided by 100
51
Absolute contraindications to exercise training
EKG changes, unstable angina, uncontrolled arrythmias, symptomatic aortic stenosis or other valvular disease, decomp HF, Acute PE or Pulm infarction, acute myocarditis or pericarditis, acute thrombophlebitis
52
Relate contraindications to exercise training
Electrolyte abnormalities, tachyarrhythmias/brady, high degree AV block, A fib with RVR, HOCM, known aortic dissection, SBP >200 Diastolic >110, mental impairment
53
``` Mets for: slow walk 2mph regular walk 3 mph brisk walk 4 mph sex shovel snow jog ```
``` slow walk- 2-3 mets reg walk 3-4 mets brisk 4-5 sex 3-4 mets shovel snow 7 mets jog 9 mets ```
54
Sex after MI
not until after 2 weeks
55
NYHA classes
I: patients can perform activities equal to/more than 7 mets, no limits physically II: Slight limitation to physical activity, comfortable at rest, equal to or more than 5 mets, cannot complete the 7 or more mets (patient who has cardiac disease that limits them to only walking, gardening and performing sexual intercourse without becoming symptomatic.) III: Comfortable at rest, marked limitation of physical activity, equal to or more than 2 mets but less than 5 mets IV: dyspnea at rest, cannot perform anything equal to or more than 2 mets.
56
Max heart rat
220 - Age
57
Borg scale of perceived exertion
6 to 20. 6 no exertion at all, 9 very light, 11 light, 13 somewhat hard, 15 hard, 17 very hard, 19 extremely hard, 20 maximal exertion The AHA recommends a rating of 13-15 for low-level graded stress testing.
58
Orthotopic heart transplant
makes up 99 percent of all cardiac transplants; bicaval technique
59
Heterotopic heart transplantation
less than 1 percent, recipient heart is left in place to assist the donor heart
60
Transplanted heart HR
Tachycardia bc denervated from vagal innervation and central regulation (parasympathetic tone) and consequently lack vagal inhibition to the SA node - lower peak heart rate - resting HTN (renal effects of calcineurin inhibitors and steroids) - Slower return to resting HR post exercise - Work capacity, CO, SBP, and total Vo2 are lower at max effort - 5 year survival 70%, 20 year survival 20% - Accelerated atherosclerosis after transplant
61
Transplanted heart HR
Tachycardia bc denervated from vagal innervation and central regulation (parasympathetic tone) and consequently lack vagal inhibition to the SA node - lower peak heart rate - resting HTN (renal effects of calcineurin inhibitors and steroids) - Slower return to resting HR post exercise - Work capacity, CO, SBP, and total Vo2 are lower at max effort - 5 year survival 70%, 20 year survival 20% - Accelerated atherosclerosis after transplant Following orthotopic cardiac transplantation, stroke volume may be reduced due to diastolic dysfunction from increased myocardial stiffness in the new heart.
62
ABI
Ankle SBP ÷ Brachial SBP
63
Cardiac conditioning causes
Wider AVO2 difference, heart does less work to bring adequate oxygen to tissue bc improved utilization of oxygen by active muscles Increased Max VO2 consumption Slower pulse, lower BP and lower rate pressure product (RPP equals myocardial oxygen demand so trained heart has lower myocardial demand)
64
VO2 max=
(HR X SV) x AVO2 difference
65
Supplemental O2 use when SaO2 falls below
90%
66
any activity that uses large muscle groups, can be maintained continuously, and is rhythmic in nature" with the goals of producing physiological adjustments to the cardiovascular system in response to the exercise is considered
aerobic exercise
67
Stages of edema
Stage 1 (pitting edema) is edema that gets worse throughout the day but is almost normal in size by the morning; it is partly, if not entirely, reversed with elevation of the affected limb. Stage 2 (nonpitting edema) is characterized by fibrosis. This marks the beginning of hardening of the skin and an increase in size. In stage 3, the swelling is irreversible and the affected area is very large. The tissue is fibrotic and unresponsive.
68
largest volume of air that can be held by a patient against a closed glottis is called
MIC. The MIC is achieved by "air stacking" consecutively delivered volumes of air that are delivered by an external resuscitator or volume ventilator with a nasal piece or mouthpiece interface. If a patient can maintain an MIC greater than his or her VC through air stacking techniques, may be able to forgo the need for a tracheostomy and be maintained on noninvasive ventilatory support alone.
69
What is an intermittent abdominal pressure ventilator (IAPV)?
A body ventilator that consists of an elastic air sac, which is worn underneath the clothing by patients who have respiratory muscle weakness. When the elastic bladder inflates with air by an external positive pressure ventilator, it causes the diaphragm to move upward. Once it deflates, the abdominal contents sag and pull the diaphragm down, allowing inspiration to occur passively. This technique can augment tidal volume by at least 300 mL or even higher if the patient has any degree of inspiratory capacity.
70
Greatest modifiable risk factor for cardiac disease
Smoking cessation
71
Central chemoreceptors in the medulla are sensitive to:
both, changes in pH and rising CO2 levels within the cerebrospinal fluid of the fourth ventricle.
72
Peripheral chemoreceptors are sensitive to:
pH, pCO2, and pO2 levels. Such receptors are located in the aortic arch as well as the carotid bodies.
73
Bisphosphonates MOA
inhibit osteoclastic bone resorption.
74
hereditary disorder characterized by congenital central hypoventilation- may also develop more normal patterns of breathing during wakefulness with episodes of apnea during sleep.
Ondine's curse
75
Fick equation:
VO2 = HR x SV x a-VO2diff
76
ratio of work to resting metabolic rate
MET
77
Exercise therapy in CHF ( what happens to Ejection fraction, HR, BP, stroke volume)
impaired contractility would cause an increase in heart rate which would result in decreased ejection fraction, lower stroke volume, and hypotension
78
``` What lobe is responsible for : voluntary motor function. interpretation of sensory information and proprioception. Long-term memory storage interprets visual information. ```
frontal parietal temporal occipital
79
where is the pharyngeal phase of swallowing triggered?
Faucial pillars. As the food bolus leaves the oral cavity and moves backward, it must pass the faucial pillars (where tonsils are located). This region contains sensory receptors that detect the presence of the bolus, which sets into motion a chain of events that result in the bolus moving through the pharynx and entering the esophagus.F
80
Three or more of the following five criteria must be met for the diagnosis of frailty: The stages of frailty are:
1. Weight loss of ≥5% in last year or Body mass index (BMI) less than 18.5 or unintentional weight loss of more than 10 pounds in the past year. 2. Exhaustion. The Center for Epidemiologic Studies Depression Scale is used. 3. Weakness (decreased grip strength measured by a dynamometer) 4. Slow walking speed of greater than6 to 7 seconds for 15 feet, or scoring less than the 20th percentile, stratified for sex and height 5. Decreased physical activity (males <383 kilocalories, kcals); females <270 kcals) or complete inactivity. 0 criteria are present: Non-frail stage 1– 2 criteria present: Prefrail stage 3– 5 criteria present: Frail stage
81
Least neurotoxic: Cyclophosphamide Bortezomib, paclitaxel, and lenolidomide
cyclophosphamide
82
Why no weakness with platinum chemotherapy
platinum analogues do not usually cross the blood-brain barrier at contemporary doses, the anterior horn motor cells are unaffected
83
The coasting effect
is a phenomenon often seen following exposure to platinum-based chemotherapeutics such as cisplatin commonly used to treat testicular cancer. Damage to the dorsal root ganglion by platinum-based chemotherapeutics causes progressive dysfunction of the dorsal root ganglion. This leads to the progressive development of sensory neuropathy that can start weeks to months after the discontinuation of chemotherapy and continue for as long as a year. When patients develop signs and symptoms of neuropathy more than a year following exposure to chemotherapy other potential causes should be vigorously sought.
84
Neuropathy found in platinum chemo
As opposed to neurotoxic chemotherapeutics such as the vinca alkaloids and taxanes which cause a length-dependent axonopathy, platinum analogues exert their putative neurotoxic effect by intercalating in the DNA of the dorsal root ganglion thereby killing or disrupting function of affected sensory nerves. Sensory neuropathy caused by platinum analogues is not length dependent, so it is not unusual to see the sensory amplitudes in the upper extremities more affected than those in the lower extremities. Because platinum analogues do not cross the blood brain barrier to affect the anterior horn cells at contemporary doses, the CMAP amplitudes and needle EMG should be normal. Nerve conduction studies demonstrate low sensory nerve action potential (SNAP) amplitudes in the median, ulnar, and radial nerves bilaterally but normal SNAP amplitudes in the lower extremities. Compound muscle action potential (CMAP) amplitudes are normal in both the upper and lower extremities. Needle electromyography (EMG) is normal.
85
DM in elderly
American Geriatric Society guidelines place greater emphasis on reduction of cardiovascular complications and minimizing the risk of hypoglycemia. A fasting plasma glucose below 200mg/dL and a hemoglobin A1c of less than 9% is sought.
86
Relative contraindications to complete decongestive therapy include
significant congestive heart failure, acute DVT, acute or untreated infection or inflammation of the affected limb, and fracture. Lymphatic drainage massage should be avoided over concurrently irradiated soft tissues
87
In addition to surgery, impending pathologic fractures of femur can be treated with
Bisphosphonates radiation therapy chemotherapy
88
The most sensitive of the studies listed for detecting osteoporosis.
Dual energy x-ray absorptiometry ( more than bone scan , xr, and CT)
89
CHF exercise type
avoid isometric, isotonic is better, Supine exercise performance increases myocardial oxygen requirements so do exercise in seated position
90
AD is characterized by:
(i) Memory impairment noted in learning or recall (ii) Aphasia, Apraxia, Agnosia or Dysexecutive function (planning, organizing, sequencing, abstracting) (iii) Cognitive deficits of sufficient severity to affect social or occupational functioning, representing a change from previous level
91
The Parkland formula =
4ml X kg X BSA % burned = 1/2 total fluid replacement in the first 8 hours. Give the remaining over 16 hours.
92
majority of brain metastasis in women.
Melanoma, breast, GI and lung cancer accounted for the
93
Mets
About 4 METs are used casually biking less than 10 mph, slow dancing, easy swimming, lifting <50 lbs, and having sexual intercourse. 2 METs are used for dressing, dusting, walking 2 MPH, playing piano, typing, and lifting <10 lbs. Typically when the patient can w About 9 METs are used for a 5 mph jog, playing soccer, pushing/pulling, and lifting 100 lbs.alk 2 flight of stairs they are able to return to sex.
94
one BKA requires how much more energy expenditure from dysvascular disease bilateral traumatic BKA 40% more energy
40%
95
one BKA requires how much more energy expenditure from dysvascular disease bilateral traumatic BKA 40% more energy One AKA from dysvascular disease requires 100% more energy Bilateral traumatic AKA It takes >200% more energy to ambulate; These patients will likely be wheelchair bound.
40%
96
Prone position drains what part of lung
Superior segments of the lower lobes
97
Contraindication to chest percussion
increased intracranial pressure (flail chest and fx rib are NOT contraindications)

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