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Physio > Level One Diseases > Flashcards

Level One Diseases Flashcards

Diseases and Conditions

1
Q

Parkinson’s Disease: Etiology

A

Possible causes: infection, drug-induced, idiopathic

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2
Q

Parkinson’s Disease: Disease Process

A

Chronic progressive neurodegenerative disease affecting CNS
Degeneration of dopaminergic neurons
Excessive acetylcholine accumulates - in a constant excitatory state
Result in akinesia and bradykinesia

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3
Q

Parkinson’s Disease: Life Span

A

Depends on symptoms and age
Death is typically secondary to complications

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4
Q

Parkinson’s Disease: Characteristics

A

Resting tremor, rigidity, bradykinesia, postural instability
Gait: loss of arm swing, trunk rotation, shuffling gait, abnormal/uncontroled change in speed
Voice impairments, mask face, pain, visual/spacial issues, hypotension, sleep disturbances

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5
Q

Parkinson’s Disease: Pattern of Progression

A

Asymmetric onset
Typically see resting tremor in one limb
More symmetrical as disease progresses

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6
Q

Parkinson’s Disease: PT Treatment

A

Timing of medication and treatment is important
Promote full AROM
Promote BIG movements
Correct kyphotic postures thru extensor strengthening
Balance exercises
Reciprocal movement
Aerobic exercise
Gait retraining - metronome
Medication: Levadopa and Selegiline
- Anixety, depression, GI, dizziness side effects

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7
Q

Parkinson’s Disease: Outcome Measures

A

Unified Rating Scale for Parkinson’s (UPDRS)
Parkinson’s Disease Questionnaire (PDQ-39)
Hoeh and Yahr

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8
Q

ALS: Disease Process

A

Progressive motor neuron disease
Gradual deterioration of both UMN and LMN
M>F
A - Amyotrophy = muscle fiber atrophy
L - Lateral = lateral column atrophy
S - Sclerosis = harden/thickening of axons

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9
Q

ALS: Etiology

A

Unknown (viral, autoimmune, toxic)
Genetic (5-10%)

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10
Q

ALS: Average Life Span

A

Death within 2-5 years

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11
Q

ALS: Characteristics

A

Rapidly progressive weakness, muscle atrophy and fasciculations (LMN)
Muscle spasticity and hyperreflexia (UMN)
Difficulty speaking and swallowing (Cranial nerve)
Decline in breathing ability
MSK pain

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12
Q

ALS: Pattern of Progression

A

Weakness starts peripherally and moves centrally
Muscle groups affects asymmetrically
Gradual involvement of all striated muscles
Bulbar palsy (oral motor dysfunction)
Progress to paralysis w/o remission
Spared: sensory system, cognition, bowel and bladder, autonomic systems
Respiratory system affected later in progression and often cause of death

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13
Q

ALS: PT Treatment

A

Early: Breathing exercises, maintain activity, functional exercise, mild aerobic exercise, energy conservation, gait aids
Late: Respiratory function, PROM, positioning, skin care, symptom relief, equipment, patient comfort

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14
Q

ALS: Outcome Measures

A

ALS Functional Rating Scale (ALSFRS) - assess disease progression and function

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15
Q

MS: Disease Process

A

Chronic, progressive demyelinating disease of CNS
Autoimmune
Damage to myelin sheaths
Impaired neural transmission
Unpredictable
Typically onset of 20-40 years

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16
Q

MS: Etiology

A

No known cause, most likely viral HLA-DR2
May be genetic link

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17
Q

MS: Average Lifespan

A

Variable depending on type and severity
Average 5-10 years less than healthy adult

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18
Q

MS: Characteristics

A

Variability in signs and symptoms depending on location of lesions
Fatigue, muscle weakness, spasticity
Balance issues, paraesthesia, optic neuritis or diplopia
Dizziness and vertigo, ataxia, bowel and bladder issues, impaired cognition, pain, depression

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19
Q

MS: Pattern of progression

A

Variable course with fluctuations
Progression to permanent dysfunction
4 Types
Exacerbating factors: heat (increases symptoms), stress, pregnancy, infections

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20
Q

MS: PT Treatment

A

Vestibular rehab, posture, proprioception, core, stretching, cardio, breathing exercises, functional strengthening, coordination, compensatory strategies, gait aid, energy conservation
Late morning sessions
Rest
Medications can be used for spasiticity

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21
Q

MS: Outcome Measues

A

Multiple Sclerosis Impact Scale
Fatigue Impact Scale
Expanded Disability Status Scale

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22
Q

4 Types of MS

A
  1. Relapsing Remitting (85%): clearly defined exacerbations followed by remission, despite remission, permanent damage may be left causing disability over time
  2. Primary Progressive (10%): slow, gradual worsening of symptoms over time
  3. Secondary Progressive: initially diagnosed with relapsing-remitting, followed by a steady progression of symptoms in which no periods of remission and symptoms steadily worsen
  4. Progressive relapsing (5%): steady progression with attacks
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23
Q

Guillain- Barre Syndrome

A

Autoimmune disease of unknown cause affecting cranial nerves and peripheral nerves
Acute demyelination
Could be triggered by viral infection (experience S&S of infection 3-6 weeks prior to neuro symptoms)
Symmetrical weakness and paresthesias begin in hands and feet and progress proximally
Rapidly progressive (1 day - 2 weeks)
Autonomic system often affected (HR, BP, temp regulation)

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24
Q

Guillain- Barre Syndrome: Recovery and Treatment

A

Weeks to years, gradual remyelination with good prognosis
1/3 permanent weakness
Early treatment: mechanical ventilation, chest physio (secretion), breathing exercises, education, maintain PROM
Late treatment: functional muscle strengthening, endurance training, gait retraining

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25
Q

Complex Regional Pain Syndrome

A

Chronic pain condition believed to be the results of dysfunction in CNS or PNS –> develops after trauma, surgery or UMNL

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26
Q

Complex Regional Pain Syndrome: Presentation

A

Changes in colour and temp of the skin over the affected limb or body part
Intense burning pain, skin sensitivity, sweating, swelling, stiffness

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27
Q

Complex Regional Pain Syndrome: Stages

A

Stage 1 (0-3m): Puffy, swelling, redness, warmth, stiffness, allodynia, positive bone scan
Stage 2 (3-6m): increased pain and stiffness, firm edema, cyanosis, atrophy, osteopenia or x-ray
Stage 3 (6m+): tight, smooth, glossy, cool, pale skin, stiffness & contractures, nail & hair changes, severe osteopenia

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28
Q

Complex Regional Pain Syndrome: PT Treatment

A

Prevention and early detection
Pain and edema management (desensitization, contrast baths, TENS, gentle massage, e-stim)
Education

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29
Q

Neurapraxia
MOI
Result
Recovery

A

MOI - compression or ischemia
Result - transient distribution
Recovery - good prognosis (minutes-weeks) as swelling resolves

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30
Q

Axonotmesis
MOI
Result
Recovery

A

MOI - crush injury (most common)
Result - distribution of axons, myelin sheath still intact, may cause paralysis of nerve
Recovery - fair prognosis (months), Wallerian Degeneration

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31
Q

Neurotmetis
MOI
Result
Recovery

A

MOI - trauma, laceration
Result - completely severed axon and sheath
Recovery - only with surgery with variable success (might not recover)

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32
Q

Wallerian Degeneration

A

Known as axonal or anterograde degeneration
“Dying back of nerve”
Nerve fibers are injured by myelin sheath still intact
Part of the axon separated from the neurons cell body degeneration distal to the injury
Occurs in a distal to proximal direction

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33
Q

Recovery of peripheral nerves following injury

A

Distal end of the portion of the nerve fiber proximal to the lesion ends out sprouts
Sprouts are attached by growth factors produced by cells in the distal myelin sheath
Axons sprout re-growth: 1mm/day
Upper arm 4-6m (up to 2 years)
Lower arm 7-9m (up to 4 years)

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34
Q

Regeneration of central nervous system

A

Compression of any part of the CNS, causing ischemia for greater than 3-5 months
Regeneration not possible

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35
Q

Segmental Demyelination

A

Focal demyelination of the myelin sheath with sparing of axons
GBS
Re-myelination restores function but the nerve conduction velocity can be slower compared to pre-damage levels

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36
Q

Osteoarthritis: Overview

A
  • Degenerative joint disease
  • Release of enzymes and abnormal biomechanical forces cause fibrillation and damage to articular cartilage
  • Loss of cartilage allows bones of joint to rub against each other
  • Can cause swelling, pain, increased bone turnover and osteophyte formation
  • Can have normal stress with abnormal chondrocyte physiology OR abnormal stress with normal chondrocyte physiology
  • Sources of pain can be bone, soft tissue, inflammation and muscle spasm
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37
Q

Osteoarthritis: 7 Risk Factors

A

Increased age, sex (W>M) genetics, physical inactivity, injury, joint stress (occupation)

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38
Q

Osteoarthritis: Subjective Questions

A
  • Pain most days?
  • Pain over the last year?
  • Worse with activity?
  • Relieved with rest?
  • How are the mornings? How long does it take the stiffness to go away, if present?
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39
Q

Osteoarthritis: Common Areas

A

Knee
- most common area, varus alignment, crepitus present, flexion contracture, abnormal gait, swipe test or patellar tap
- loose bodies could be present: locking or catching from free floating bone or cartilage
- treatment: joint traction, open kinetic chain exercises, isometrics through range
Hip
- Common, walking with Trendelenburg, groin pain, osteophytes, flexion deformities and increased IR
Spine: osteophytes in facet joints of lumbar spine can cause stenosis
Hand
- PIP, DIP and CMC
Foot
- first metatarsal joint, osteophytes can form at this joint, may have bunions
Uncommon joints –> shoulder, elbow, wrist (can occur if scaphoid #) and ankle

Treatment: Exercise (strengthen, stretch muscles around OA joint), activity modification, weight loss, acetaminophen

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40
Q

Signs of Septic Arthritis

A
  • Unable to move the limb
  • Intense joint pain
  • Joint swelling
  • Joint redness
  • Low fever
  • Chills may occur
  • Possible tachycardia
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41
Q

Inflammatory Arthritis Characteristics

A

Pain: Yes - worse in AM
Swelling: Moderate to severe
Warmth: Sometimes
Redness: Sometimes
Morning Stiffness: > 1 hr
Systemic Features: Sometimes - fever, fatigue
Increase in Erythrocyte Sedimentation Rate: Frequent

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42
Q

Non-Inflammatory Arthritis Characteristics

A

Pain: Yes - worse after use
Swelling: Mild
Warmth: Absent
Redness: Absent
Morning Stiffness: < 30 minutes
Systemic Features: Absent
Increase in Erythrocyte Sedimentation Rate: Uncommon

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43
Q

Rheumatoid Arthritis

A

Autoimmune disease
Synovitis is the main feature
Changes at the joint level lead to: immobility and consolidation of a joint, bones become osteopenic, ligaments and tendons become damaged or ruptured, surrounding membrane deteriorates leaving joint unstable and prone to deformity

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44
Q

Rheumatoid Arthritis: Presentation

A
  • Symmetrical pattern, pain, fatigue, stiffness (decreased ROM), swelling, joint deformity, muscle atrophy
  • Abnormal antibody HLA-DR4 in 80% of people with RA
  • Increased risk: after mother gives birth, cigarette smoking, pollution
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45
Q

Rheumatoid Arthritis: Criteria

A

Need 4 out of 7 (for at least 6 weeks)
- Morning stiffness > 1 hr
- Arthritis of >/= 3 joints
- Arthritis of hand joint
- Symmetric arthritis
- Rheumatoid nodules
- Radiographic changes
- Serum rheumatoid factor –> antibodies produced by immune system that attack healthy cells. Associated with autoimmune disease

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46
Q

Rheumatoid Arthritis: Deformities

A
  • Hallux valgus: 1st MTP synovitis, big toe lateral, ligament laxity and erosion sublux –> dislocation, prox phalanx drifts lateral, causes pronation of midfoot
  • MTP subluxation: synovitis, displacement of the flexors, unopposed extensors pull the phalanx into hypertext, metatarsal head prolapses and get dislocation and lateral drift of toes… sign = callouses
  • Claw toe: MTP and PIP synovitis, usually involves 2nd toe, flex of PIP and hypertext of DIP (similar to boutonniere)
  • Mallet toe: flex of DIP, affects longest
  • Ulnar drift: MCP synovitis –> MCP sublux causes re-positioning of tendons and pull of phalanges towards ulnar side of hand
  • Swan neck deformity: flex of MCP (not always), hypertext of PIP, flex DIP
  • Boutonniere deformity: zig zag deformity - MCP hypertext (not always), flex of PIP, hypertext of DIP
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47
Q

Rheumatoid Arthritis: Management

A
  • Meds –> DMARDs, NSAIDs, Tylenol, cortisone
  • DMARDs: slow progression of disease process and can save joints and other tissue from permanent damage and dysfunction
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48
Q

Rheumatoid Arthritis: Acute Stage Treatment

A

Acute Stage: Disease Flare Up
- Protect: use resting splints, brace joint during ADLs, adaptive tools to reduce joint strain during ADLs
- No stretching
- Energy conservation
- Gentle pain free ROM
- No heavy lifting
- Ice to reduce inflammation
- Heat only applied briefly in AM to reduce morning stiffness
- Hydrotherapy

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48
Q

Rheumatoid Arthritis: Chronic Stage Treatment

A

Chronic Stage: No disease flare up
- Capitalize on decreased pain and increased energy
- ROM full and pain free
- Increase cardiovascular activity - aquatics is a good idea
- Strength and endurance training - pain free w/ lighter weights
- Use splints/braces while exercises
- Continue joint protection strategies
- Use ice after activity to reduced inflammation
- Heat before activity in needed for stiffness

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49
Q

Rheumatoid Arthritis: Surgery

A
  • Remove (joint surface/bone removed to decrease pain)
  • Re-align (tendon rupture)
  • Rest (arthrodesis) - joint fusion
  • Replace (arthroplasty) - joint replacement
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49
Q

Rheumatoid Arthritis: Commonly Affected Joints

A
  • Atlanto-axial joint (especially transverse ligament)
  • TMJ: end stage might result in fusion of open bite
  • Shoulder: humeral head moves superiorly
  • AC joint:
  • Elbow: loss of extension
  • Wrist
  • MCP and PIP
  • Knee: baker’s cyst, flexion deformity, valgus deformity and quad wasting
  • MTPs
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50
Q

Spondyloarthritis

A

Umbrella term for group of inflammatory diseases that have common characteristics
Most common is Ankylosing Spondylitis
Other common conditions include: psoriatic arthritis, enteropathic spondylitis, reactive arthritis and JIA
Common features: inflammation of the spine, synovitis (typically unilateral), enthesitis, extra-articular features (uveitis, skin, genitourinary tract)
NO RHEUMATOID FACTOR (seronegative)
Can be hereditary (HLA-B27)

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51
Q

Ankylosing Spondylitis: Common Features

A
  • HALLMARK SIGN: sacroiliitis - deep dull pain in buttocks due to inflamed SI joint
  • Low back pain
  • Synovitis
  • Inflammation of the eye
  • Enthesitis (inflammation where ligaments, tendons and muscles attach to bone)
  • Syndesmophytes: bony growth within ligaments on either side of a joint which can cause fusion/rigidity
  • No RF (sernoegative)
  • Can be hereditary (HLA-B27)
  • Stiffness/fusing of the spine by inflammation
  • Disease of young adults: onset of before 40
  • More males than females
  • Postural deformities - kyphosis, decreased lumbar lordosis, forward head posture
  • Other: inflammation of bowels, lungs and heart
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52
Q

Ankylosing Spondylitis: Clinical Criteria

A
  • LBP and stiffness for more than 3 months that improves with exercise but is not relieved with rest
  • Limitation of motion of L spine (due to pain, tissue contracture, movement guarding, fusing)
  • Limitation of chest expansion (diaphragmatic breathing)
  • Decreased strength d/t disuse -
  • Joint effusion
  • Pain
  • Flexion posture
  • Fatigue due to disease process
  • Cardiac involvement
  • Decreased vital capacity due to rib involvement
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53
Q

Ankylosing Spondylitis: Goals and Management

A
  • Meds: NSAIDs, corticosteroids, DMARDs & biologics
    Goals:
  • Reduce stiffness and increase ROM
  • Exercises, stretching, heat and postural education
  • Increase endurance and muscle strength
  • Increase respiratory function through cardio and relaxation/breathing exercises
  • NO RUNNING
  • Control/decrease inflammation
  • Pain management
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54
Q

Ankylosing Spondylitis: Postural Assessment

A
  • Tragus to wall
  • Lateral trunk flexion
  • Trunk flexion
  • Trunk extension
  • Chest expansion
  • Cervical mobility
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55
Q

Spondyloarthritis: Psoractis Arthritis

A
  • Associated with psoriasis
  • Occurs equally in M and F
  • Usually occurs on 30-50s but can begin in childhood
  • Chronic, erosive, inflammation more commonly found a digits, large joints of axial skeleton, back and SI joints
  • Meds: acetaminophen, NSAIDs, DMARDs, biologics, corticosteroids
  • PT treatment: joint protection, maintain optimal joint mechanics and postures, cardiovascular endurance
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56
Q

Spondyloarthritis: Enteropathic Arthritis

A
  • Associated with inflammatory bowel disease: Crohn’s or colitis
  • Long lasting inflammation from bowels –> bacteria can enter and circulate in blood stream
  • Disease “flares” normally subside in 6 weeks, but re-occurrence is common
  • Joints affected are often the peripheral joints but may affect spine and SI joint
  • Abdominal pain and bloody diarrhea are possible
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57
Q

Spondyloarthritis: Reactive Arthritis

A
  • Painful form of inflammatory athritis
  • Most often short lasting but on occasion can become chronic
  • Occurs in reaction to an infection by certain bacteria (possibly STI) in bowel it GI tract
  • Hot, swollen joints often affect knees and ankles
  • Persistent low back pain which tends to be worse at night or in the morning
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58
Q

Juvenile Idiopathic Arthritis: Types

A
  • Several subtypes: oligoarthritis (4 or fewer joints), seronegative polyarthritis (5 or more joints), seropositive polyarthritis, enthesitis-related arthritis, psoriatic JIA, undifferentiated arthritis
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59
Q

Juvenile Idiopathic Arthritis: Common Features

A
  • Joint pain
  • Stiffness
  • Warm swollen joints
  • Eye issues (uveitis)
  • Genetic marker HLA-B27
  • Fatigue
  • Abnormal Erythrocyte Sedimentation Rate (ESR)
  • RF only present in small % of JIA
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60
Q

Juvenile Idiopathic Arthritis: Diagnosis & Treatment

A
  • S & S must be present for 6 weeks to make diagnosis

Treatment:
- Activity modification
- Postural education
- Increase strength during non-active times of disease
- Reduce pain
- Some will go into remission

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61
Q

Outcome Measures of Arthritis

A
  • Health Assessment Questionnaire
  • Euro QoL
  • MACTAR
  • KOOS/HOOS
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62
Q

Gout

A
  • Increased serum uric acid (hyperuricemia)
  • Uric acid forms stones called tophi formations which become deposited into joints, synovium, cartilage, tendons causing pain and inflammation
  • Most common area: knee and great toe
  • Meds: NSAIDs, cox2-inhibitors corticosteroids & ACTH
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63
Q

Gout: PT Goals

A
  • Rest
  • Injury prevention education
  • Restore normal flexibility and function
  • As inflammation subsides, add strength and functional exercise
  • Do not exercise a red, hot & swollen joint - focus on pain reduction
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64
Q

Pseudogout

A
  • Similar to gout
  • Painful, swollen joint
  • Different type of crystals
  • No tophi formation
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65
Q

Poliomyelitis & post polio

A
  • Neuromuscular disease causing PERIPHERAL neuromuscular fatigue
  • Virus enters the CNS
  • Can lead to paralysis
  • Attacks neurons at the anterior horn of the spinal cord
  • Leads to loss of innervation of peripheral muscles
  • Some regrowth of neurons can occur and some movements can recover… motor units become enlarged
  • Post-polio: can experience new symptoms 15-30 years after the initial virus… decrease muscular function, acute weakness with pain and fatigue
  • Use symptomatic management
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66
Q

Movement Disorder: Huntington’s Chorea

A
  • Progressive, hereditary condition characterized by abnormal movement and mental deterioration
  • Quick jerky movements, involuntary, purposeless, uncontrolled movement
  • Swallowing and speech affected
  • Due to loss of neurotransmitters and GABA
  • PT Treatment: symptom management, patient safety, maintain enough nutrition
67
Q

Movement Disorder: Essential Tremor

A
  • Common neurological disorder usually seen as shaking hands evoked by voluntary movements
  • No other neuro signs
  • Most frequent movement disorder
  • Increases with fatigue and nervousness
68
Q

Movement Disorder: Hemiballism

A
  • Very rare movement disorder
  • Exhausting violent movements
  • Due to damage within various areas of the basal ganglia
  • Some go into spontaneous remission
69
Q

Movement Disorder: Tardive Dyskinesia

A
  • Difficult to treat and often incurable form of dyskinesia
  • Motor control disorder secondary to use of anti-psychotics for control of psychosis
  • Random movement of tongue, lips and jaw
  • May affect limbs as well
70
Q

Movement Disorder: Tourette’s Syndrome

A
  • Repetitive, involuntary, stereotypical movements and utterances (tics)
  • Combination of genetic and environmental factors
71
Q

Inflammatory/Infection CNS Condition: Meningitis

A
  • Inflammation of meninges (Pia, arachonoid and dura)
  • Increased risk of infarctions, blood clots and hydrocephaly
  • Presentation: can present as acute (hours - days); subacute (2 plus weeks); chronic (1 month plus) - headache, fever, vomitting, rigidity of the neck
  • Treament considerations: monitor vitals, mobilize as tolerated, elevate the patient toward vertical position slowly
  • Types: 1) Aseptic: fungus, 2) TB: absess or edema, 3) Bacterial: in child or infant
  • Test: Brudzinski’s sign: knees and hips will flex when neck is passively flexed in supine
72
Q

Inflammatory/Infection CNS Condition: Encephalitis

A
  • Infection of the brain and spinal cord
  • Caused by infection (viral, bacterial)
  • S/S: headache, nausea, vomitting, decreased LOC, coma
  • Last for days - months
  • Can result in focal brain damage
73
Q

Inflammatory/Infection CNS Condition: Lyme Disease

A
  • From bacteria (from tick)
  • May occur in stages
  • Stage one: local presentation: local rash, erythema, flu like symptoms
  • Stage two: infection spreads through blood stream - headache and stiff neck, Bell’s palsy, MSK fatigue and weakness, tachy, brady, arrythmia, myocarditis
  • Stage three: long term neurological issues - neuropathy, arthritis, cognitive deficits
  • Mimics MS, fibro, chronic fatigue syndrome, GBS
  • PT Treatment: releive pain, prep deconditioned patients for home exercises, improve functional strength, educate on FITT, pace and plan, exercise without exacerbating symptoms
74
Q

Diseases Affected Neuromuscular Junction: Maysthenia Gravis

A
  • Rare, chronic autoimmune disease
  • Antibodies block acetacholine (ACh) receptors at post synaptic membrane of neuromuscular junction
  • Failure of muscle contraction due to impaired nerve signal
  • Characteristics: weakness and increased fatigue with repeat contraction, improved with rest
  • Facial muscles: eye muscles
  • Progression to generalized muscle weakness
  • Proximal muscles more involved than distal
  • PT Treatment: Strengthening after administering ACh inhibitors (prevent breakdown of ACh in neuro junction), exercise followed by rest, breathing exercises, pacing and planning, energy conservation
75
Q
A
76
Q

Poliomyelitis & post polio: Clinical manifestations and PT treatment

A
  • Clinical manifestations: slow progression with new asymmetrical muscle weakness and atrophy, polio gait (atrophy of quads leads to inability to keep knee extended in heel strike - knee pushed back to keep from buckling), abnormal levels of fatigue, muscle pain, sensory not affected
  • PT Treatment: general body conditioning, light to moderate aerobic conditioning, balance period of rest and activity, do not exercise to point of fatigue, exercise when less fatigued (mornings normally best), education on energy conservation, breathing exercises, strength varies throughout the day
77
Q

Osteoporosis/Osteopenia: Overview

A
  • Depleted bone mineral density (BMD)
  • Women 10x more than men, especially post menopause
  • Risk factors: 50+ years old, gender F>M, inactivity, menopause hereditary factors, nutrition, smoking, long term steroid use
  • Common fracture areas: thoracic spine, femoral neck, proximal humerus, proximal tibia, pelvis, distal radius
78
Q

Osteoporosis/Osteopenia: Common Presentation

A
  • Chin poke/head forward posture
  • Increased thoracic kyphosis
  • Increased lordosis
  • Rounded/protracted shoulders
  • Loss of lumbar lordosis
79
Q

Osteoporosis/Osteopenia: Suggested Spinal Movement

A
  • Thoracic extension
  • Lumbar extension
  • AO flexion/upper cervical flexion (chin tuck)
  • Cervical rotation
80
Q

Osteomalacia

A
  • Softening of the bones caused by impaired bone metabolism due to inadequate levels of available phosphate, calcium and vitamin D or because of resorption of calcium.
  • Known as “Rickets” in children
  • Present with diffuse joint and bone pain, muscle weakness, soft deformed bones, fractures due to weight bearing, forward flexed posture
81
Q

Paget’s

A
  • Caused by excessive breakdown and formation of bone, followed by disorganized bone remodelling
  • Causes bones to weaken, resulting in pain, misshapen bones, fractures and arthritis.
  • Pelvis, femur, and lower lumbar vertebrae are most commonly affected
82
Q

Osteogenesis Imperfecta

A
  • Brittle bone disease
  • Genetic disorder
  • Involved defective development of connective tissue (lack of type 1 collagen)
  • Varies in severity (mild-severe)
83
Q

Osteopetrosis

A
  • Vary rare, inherited deficiency in carbonic anhydrase
  • Osteoclast dysfunction - do not get bone breakdown
  • Despite excess bonem this patient population has brittle bones and an increased risk of fracture
84
Q

Bone Infection: Osteomyelitis

A
  • Inflammation response in bone, caused by infection (usually due to staph infection)
  • Can occur with sepsis, open trauma, infected surgical implant
  • Children and immunosuppressed at highest risk
  • M>F
  • Red flags: non mechanical pain (pain at night and at rest), systemic features (fever, redness, heat, swelling, feeling of malaise)
85
Q

Pain

A
  • Real or perceived damaging stimuli. Signals travel to brain via lateral spinothalamic tract.
  • 2 types of fibres conduct at different speeds which explains why we initially feel a sharp localized pain when injured but this turns into a dull pain
  • A delta (sharp, high threshold)
  • C fibers (low threshold, unmyelinated, aching, diffuse) – meds don’t work well
86
Q

Chronic Pain

A
  • Pain that persists past the normal time of healing (6 months after an injury)
87
Q

Visceral Referred Pain

A
  • Heart: chest and upper arm (typical), back, neck, jaw or stomach (atypical)
  • Kidney: may refer to lumbar spine (ispilateral flank) or upper abdomen
  • Kidney stones: acute flank pain radiating to groin/perineal
  • Urinary bladder: subpubic or thoracolumbar region
  • Diaphragm: refers to C4 dermatome region
  • Gallbladder: posterior thorax
  • Appendix: R lower quad
88
Q

Chronic Fatigue Syndrome

A
  • Diagnosed by exclusion
  • Persistent ot relasping fatigue for a least 6 months, not resolved with bed rest, reduced daily activity by at least 50%
  • Cause is unknown
  • Typically occurs after viral infection but may be linked to hormones
  • Treatment: analgesics, anti-inflammatories, NSAIDs, nutrition, psych support
  • PT Treatment: build up exercise tolerance, check O2 levels
89
Q

Fibromyalgia

A
  • Chronic pain syndrome affecting muscle and soft tissue
  • S/S: headaches, sensitivity to stimuli, fatigue, muscle pain, generalized aching, sleep disturbances
  • Anxiety and depression are common
  • 18 tender points, 9 pairs: occiput, low cervical, traps, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter, knee
  • Treatment: anti-inflamm, muscle relaxants, psychosocial support, nutrition
  • PT Treatment: energy conservation, aquatic therapy, pain relief modalities, acupuncture, light aerboic exercise, strengthening and stretches, breathing and relaxation
90
Q

Obesity

A
  • BMI = weight (kg)/height (m2)
  • Abdominal obesity = independent predictor or morbidity and mortatility
  • Health risks assoicated with obesity: increase CVA, strokem HTN, lipids, type 2 diabetes, gallballer disease, menstral irregularity, cancer, osteoarthritis, breathing problems
  • “Treatment”: lifestyle changes, behaviour therapy, pharmacology surgery, exercise program
91
Q

Cancer

A
  • Tumour or neoplasm: benign or malignant, soft tissue or bone
  • Most significant symptoms of growing neoplasm is pain
  • Metastasis: cancer cells travel through the blood stream and begin growing far away from original tumour
  • Risk factors: chemicals, radiation, viral, genetics, obesity, high in fat diet, low in vitamin diet, chronic stress
92
Q

Four Most Common Types of Cancer

A
  1. Carcinoma: tend to grow more quickly
  2. Sarcoma: grow more slowly but are relentless
  3. Lymphoma: some slow and some fast growing
  4. Leukemia’s and myelomas: affect blood and blood forming organs
93
Q

Side Effects of Cancer Treatment

A
  • Fatigue, pulmonary fibrosis, renal failure, sterility, peripheral neuropathy
  • Chemo can be absorbed through the skin - contact precautions
94
Q

PT Treatment: Cancer

A
  • Fatigue management, function and mobility management, bed mobility and positioning, symptom management, exercises
95
Q

PT Treatment: Post Mastectomy

A
  • Regain pain free full ROM of shoulder
  • Prevention and reduction of edema
  • Early post of exercise
96
Q

PT Treatment: Bone Marrow Transplant

A
  • Strict isolation and bed rest
  • Focus on restoring function and overcoming deconditioning
  • If platelets less than 20,000 then exercise is a contraindication
97
Q

Lymphedema

A
  • No cancer but common after radiation, older age, axillary lymph node dissection, arm infection/injury, obesity and weight gain
  • Two types: primary (rare, inherited) and secondary (identifiable damage or too obstruction of normally functioning lymph nodes)
98
Q

Reduce the Risk of Lymphedema

A
  • Protect your arm and leg
  • Rest your arm or leg while recovering
  • Avoid heat on your arm or leg
  • Elevate your arm or leg
  • Avoid tight clothing
  • Keep your limb clean
99
Q

Education for Patient with Lymphedema

A
  • Exercise: light exercise
  • Wrapping
  • Massage
  • Pneumatic compression
  • Compression garments
100
Q

Cancer Exercise Precautions and Contraindications

A
  • Precautions: swollen ankle, fatigue, vomiting, diarrhea, unexplained weight loss/gain, SOB with low level of exertion, anemia, low platelets, low WBC
  • Contraindications: racing pulse, fever, pain in back or neck or bone, calf pain, chest pain, nauseated with exercising, confused or disorientated, dizzy or faint, blurred vision, sudden SOB, very weak or tired
101
Q

RED FLAG: Cancer Questions

A
  • Unexplained weight loss
  • Night pain
  • Night sweats
  • Feeling of malaise
102
Q

HIV/AIDS

A

AIDS: CNS manifestation of HIV
- Cause: HIV1 or HIV2, loss of immune system function
- Transmission: blood, semen, CSF, breast milk, vaginal/cervical secretions
- NOT IN: urine, stool, sweat, vomit, saliva, tears, nasal secretions
- S/S: alterations in memory, confusion, disorientation, motor defects, ataxia, gait disturbances, loss of fine motor coordination, peripheral neuropathy

103
Q

HIV/AIDS PT Treatment

A
  • Moderate aerobic, strength, avoid exhaustive exercise
  • Acute: reduce to mild levels, activity pacing, energy conservation, stress and pain management, maintain tissue length
  • Chronic: maintain growth and development, improve QOL, decrease pain
  • Use PPE when exposed to blood
104
Q

Liver Disease/Failure

A
  • Livers main function is to allow fluid to enter tissues, clotting factors, ammonia metabolism, remove bilirubin from break down of RBCs
  • S/S: jaundice, itching, big belly, low albumin, bleeding, esophageal varices
105
Q

Hepatitis

A
  • Hep A: transmitted by fecal-oral route, usually acute, self-limited episode, vaccine
  • Hep B: transmitted by mucous membrane, perinatal, sexual transmission and injection drug use, no cure, vaccine available
  • Hep C: transmitted by injection, sexual contact, perinatal and hemodialysis, no vaccine
106
Q

Haemophilia

A
  • Bleeding disorder
  • Genetics: hereditary clotting factor deficiencies
  • X linked recessive gene
  • Males have the condition and the gene causes it is carried by women
  • S/S: big bruises, bleeding in muscle and joints, especially knees, elbows and ankles, prolonged bleeding after a cut/tooth removal
  • Joint bleed symptoms: tightness and pain before any bleeding, swollen and hot to touch, hard to move, all movement lost, severe pain
  • Treat joint bleeds: VIII factor given
107
Q

Anemia

A
  • Deficient RBCs, hematocrit or Hb
  • Effects amount of O2 that can be carried to the cells
  • Normal Hb levels = 14-18 M and 12-16 F
  • If Hb drops < 8 then exercise needs to be decreased
  • From blood loss, destruction or decreased or improper production
108
Q

Diabetes

A
  • Inaffective carbohydrate metabolism; results in hyperglycemia
  • Type 1: Insulin Dependent - S/S; increased urination, weight loss, dehydration
  • Type 2: Insulin resistance - S/S: obses, hyperpigmented skin in axilla, groin and back of neck, HTN, nerve, kidney or heart problems
  • Common issues: ketoacidosis - dangerous ketone levels in the blood (drop pH) + pressure ulcers
  • Have snack before exercise, monitor blood sugar levels, avoid exercise at night
109
Q

Hypoglycemia

A
  • Dizzy, nausea, weak, unsteady gait, confusion, fainting
  • Administer sugar and monitor blood glucose
  • Exercise will drop blood sugar so be aware
110
Q

Hyperglycemia

A
  • Blurred vision, fatigue, polydipsia (excessive thirst), frequent urination, abnormal breathing, acetone breath, weak and rapid pulse, weakness
  • Long term affects: damage to small vessels, large vessels, peripheral neuropathy
111
Q

Sepsis: Overview

A
  • Infection/trauma –> SIRS (Systemic Inflammatory Response Syndrome) –> Sepsis –> Severe Sepsis –> Septic Shock
  • More likely after a viral illness (like a cold) or minor injury
  • Potential complications: respiratory failure, renal failure, GI bleed, anemia, DVT, IV catheter-related bacteria, electrolyte abnormalities, hyperglycemia
112
Q

SIRS: Systemic Inflammatory Response Syndrome

A
  • Non specific can be caused by ischemia, inflammation, trauma, infection
  • Not always related to infection
  • Need to have 2 or more of the following: fever more than 38 or less than 36, heart rate more than 90, RR more than 20, abnormal WBC count
113
Q

Sepsis

A
  • Two of following: body temp above 38.3 or below 36, HR higher than 90, RR higher than 20
114
Q

Severe Sepsis

A
  • Upgraded to severe sepsis if exhibit at least one of the following that indicate organ is failing: decrease in urine output, change in mental status, decrease in platelet count, difficulty breathing, abnormally heart pumping, abdominal pain
115
Q

Septis Shock

A
  • S/S of severe sepsis plus extremely low blood pressure
116
Q

Amputees: Causes

A
  • Vascular: ischemia, diabetes, arterial insufficiency, peripheral vascular disease
  • Malignant tumours
  • Trauma
117
Q

Amputees: Risk Factors

A
  • Age
  • Gangrene
  • Infection
  • Comorbidites
  • Complications
  • Sensory neuropathy
  • Ischemia
  • Endocrine control and pathogens (MRSA and Staph)
118
Q

Amputees: Types

A
  • Transfemoral: above knee
  • Transtibial: below knee
  • Ankle disarticulation
  • Symes
119
Q

Amputees: Stump Pain

A
  • Stump or incisional pain: tenderness in the stump, around area where the skin was cut
  • Phantom sensation: tingling, pressure, itching or tickling in the part of the leg that has been removed
  • Nerve or neuropathic pain: mild to severe buringing, squeezing, cramping or stabbing pain in your stump
120
Q

Amputees: Stump Exercises

A
  • Hip AB in side lying
  • Hip EX in side lying
  • SLR
  • Bridging
  • Quad sets
  • Quads over roll
  • Knee extension in sitting
  • Hamstring curls
  • Arm exercises
121
Q

Amputees: Stump care DOs

A
  • Wash hands before touching stump
  • Rinse the soap off stump well and pat dry
  • Use clean cotton for cleaning skin folds
  • Check stump each day
  • Check for signs of pressure or infection
  • Touch and gently massage your stump regularly to decrease the sensitivity
122
Q

Amputees: Stump care DONTs

A
  • Put lotion on open areas or broken skin
  • Put any chemical or strong ointments on your stump
  • Expose your stump to extreme temps
  • Use heating or ice on stump
  • Touch open or broken skin - stump could become infected
123
Q

Amputees: Stump Infection Signs

A
  • Redness or heat along incision
  • Green, yellow or white drainage
  • Opening on incision
  • Fever and chills or flu like symptoms with any drainage from your incision
124
Q

Connective Tissue Disorder: Systemic Lupus Erythematosus

A
  • Can involve joints, kidney, CNS, pulmonary, butterfly rash, localized erythema and edema, alopecia, photosensitive, mucosal ulcers, Raynaud’s, effusion in joints, positive for ANA
125
Q

Connective Tissue Disorders: Scleroderma

A
  • Rare autoimmune disease affecting blood vessels and connective tissue
  • Characterized by fibrous degeneration of connective tissue of the skin, lungs and internal organs
  • Autoimmunity provokes massive fibrotic tissue response which can lead to joint contractors, PF and GI dysmotility
126
Q

Connective Tissue Disorders: Ehlers-Danlos

A
  • Genetic
  • Defect in collagen synthesis, displays hypermobility can affect cardaic
127
Q

Connective Tissue Disorders: Marfans Syndrome

A
  • Genetic
  • Lack of fibrin, long hands, loose joints, scoliosis, often eye and heart involvement
128
Q

Connective Tissue Disorders: Larsen Syndrome

A
  • Genetic
  • Multiple joint dislocations
  • Foot deformities
  • Prominent forehead
  • Wide spaced eyes
129
Q

Structural Deformities: Achondroplasia

A
  • Growth of cartilage in the epiphyses of the bones resulting in the limbs remaining short and is transmitted as an autosomal dominant gene
130
Q

Structural Deformities: Multiple Epiphyseal Dysplasia

A
  • Cluster of disorders affect epiphyseal growth plates, short stature and limbs
131
Q

Structural Deformities: Diastrophic Dysplasia

A
  • Rare genetic disorder characterized by twisting of metatarsals
132
Q

Structural Deformities: Metaphyseal Dysplasia (Pyle’s Disease)

A
  • Outer part of shaft of long bone is thinner than normal
133
Q

Structural Deformities: Acromegaly and Giantism

A
  • Both have over active pituitary gland and causing increase growth hormone
  • Giantism in children, affects growth plates/long bones = really tall individuals
  • Acromegaly in adults causing enlarged hands, feet and face in adults
134
Q

Burns: MOI

A
  • Thermal or not thermal
  • Flame burns, hot liquids, contact burns (stove), electrical burns, chemical burns, friction burns, radiation burns
135
Q

Degrees of Burns

A

First: Superficial - just redness
Second: Partial thickness (epidermia and part of dermis) - blistering
Third: Full thickness (epidermis, dermis and subcutaneous) - necrosis

136
Q

Burn: Zones

A
  • Coagulation: the point of maximum damage, irrevserible
  • Statis: decreased tissue perfusion, potentially salvageable
  • Hyperemia: will recover unless severe spesis
137
Q

Burns: Rule of Nine ADULTS

A
  • Assesses percentage of burns in adults
  • Head 9
  • Anterior trunk 18
  • Posterior trunk 18
  • One arm 9
  • One leg 18
  • Groin 1
138
Q

Burns: Rule of Nine CHILDREN

A

Head 18
- Anterior trunk 18
- Posterior trunk 18
- One arm 9
- One leg 14
- Groin 1

139
Q

Effects of Burns

A
  • Cardiovascular system: increased capillary permeability, intersitial edema, peripheral vasoconstriction, hypovpemia, myocardial depression, hypotension and decreased organ perfusion
  • Resp system: bronchoconstriction, ARDS
  • Metabolism: increased 3x and can persist up to two years post
  • Immune system: compromised
  • Renal: due to loss of fluid, there is vasoconstriction, decreased GFR, increased myoglobin gets processed by kidneys and can block tubules
140
Q

Signs of Inhalation Injury

A
  • Singed eyebrows/nasal hairs/burnt face
  • Black oral/nasal discharge
  • Swollen lips
  • Hoarse voice
  • Abnormal oxygenation
  • History of being enclosed in closed room
  • Inhalation injury process within 24 hours
  • 24-48 just pulmonary edema
  • 48 hours + bronchiolitis, alveolitis, pneumonia, ARDS
141
Q

Management for Inhalation Injury

A
  • Early mobilization
  • Breathing exercises
  • Postural drainage
  • Medication
142
Q

Treatment for Inhalation

A
  • Prevent respiratory complication
  • Control edema
  • Maintain joint ROM
  • Maintain strength
  • Prevent excessive scarring
  • Mobility started immediately
  • AROM and PROM
143
Q

Burns: Positioning

A
  • Safe position for wrist: wrist 30, MCP 70 and DIP/PIP 0
    -Common contractures: neck flexion, neck extension, limited abduction, elbow flexion, hip flexion
  • Will want to be in position that does not pull skin
144
Q

Burns: Contraindications for Exercise

A
  • Exposed joint
  • Fresh skin graft
  • DVT
  • Compartment syndrome
145
Q

Skin Graft Treatment

A
  • Scar massage
  • Sun protection
  • ROM
  • Pressure garments
  • Strengthening can begin in 3-4 weeks with consent from specialist
146
Q

Skin Condition: Psoriasis

A
  • Autoimmune disease that effects skin
  • Finger nails can be affected
  • Scalp, hands, soles of feet, genitals
  • Complications: desire to scratch, increased risk of CVD, shortened lifespan
147
Q

Skin Conditions: Eczema

A
  • Imflammation of dermis
  • Itchy, red, scaly disorder
  • Two types: atopic or contact
148
Q

Herpes Virus

A
  • Commonly due to chicken pox or shingles
149
Q

Herpes Zoster

A
  • Shingles
  • Pain and tingling along dermatome, rash/blister last up to one month, pain described as burning, stabbing, aching, fever, GI distrubances, malaise, headache
150
Q

Competing Diagnosis: Stress

A
  • Regulated by amygdala, SNS and adrenals
    S/S: increased muscle tension, headaches, abdominal pain, decreased immune fxn, anxiety, moodiness, irritability, withdrawal
151
Q

Competing Diagnosis: Thyroid Hormonal Dysfunction

A
  • Hyperthyriodism: elevation of metabolism & HR, swelling and enlargement in anterior neck, increased HR/RR, palpitations, breathlessness, CNS changes, MSK changes
152
Q

Competing Diagnosis: Grave’s Disease

A
  • Causes: hyperthyroidism, anterior pituitary tumor
  • S/S: fever, weight loss, exercise intolerance, goiters, bulging eyes, tachycardia
153
Q

Parathyroid Dysfunction

A
  • Increase calcium in blood
  • Taken from bone
154
Q

Adrenal Glands Dysfunction

A
  • Secretes hormones
  • Part of fight or flight
155
Q

Cushing’s Disease

A
  • Metabolic disorder resulting from prolonged exposure to cortisol
  • Causes: tumor, anterior pituitary tumor, medications
  • S/S: HTN, moon face, central obesity, abdominal striations, acne
156
Q

Addison’s

A
  • Autoimmune process against the adrenal cortex, fatal if not treated, great prognosis if treated
  • S/S: weakness, fatigue, anorexia, hypoatremia, hypoglycemia, hyperpigmentation
157
Q

Shock

A
  • S/S: increased thrist, anxious, nausea, increased and weak HR, cold/clammy, increased and shallow RR, dilated pupils, altered LOC
158
Q

Temperature Conditions: Heat Exhaustion

A
  • Not due to elevated temps
  • Sudden stop in exercise causes pooling in LE and decreased central volume
  • Results in postural hypotension, reversed by supine lying with pelvis/legs elevated
159
Q

Heat Stroke

A
  • Body temp > 40
  • Dizziness
  • Weakness
  • Headache
  • Altered sensorium
  • Hypotension
  • Tachycardia
  • Hyperventilating
  • Rapid pulse
  • Treatment: cooling by promptly immersing in ice water bath for 5-10 mins, fluids
160
Q

Heat Syncope

A
  • Results in weakness, fatigue, and loss of motor tone
  • Blurred vision and elevated body temperature
161
Q

Heat Cramps

A
  • Depletion of both water and salt
  • After vig PE in hot environments
162
Q

Mood and Mental Disorders

A
  • Schizophrenia: mood shifts, bizarre ideas, widthdrawn
  • Paranoia: delusions, suspicious
  • Anxiety: PTSD, panic, OCD
  • Depression
  • Bipolar disorder
163
Q

Dementia: Alzheimer’s

A
  • Most common type
  • Slow progressive brain disease
  • Brain changes
164
Q

Dementia: Lewy bodies

A
  • Similar to Alzheimer’s but have earlier symptoms of sleep disturbances, well formed visual hallucinations and slowness, gait imbalance
165
Q

Mad Cow

A
  • Fatal brain disorder
  • Rapid progression
166
Q

Wernicke-Korsakoff Syndrome

A
  • From alcohol misuse
  • Memory problems
  • Brain changes

Physio (11 decks)

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