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Medical Conditions > Med Conditions II Final > Flashcards

Med Conditions II Final Flashcards

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USMLE® Step 1 flashcards
1
Q

ACTH Dependent - Cushings Disease

A

pituitary adenoma- secretes ACTH

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2
Q

ACTH independent- Cushing’s syndrome

A

adrenal adenoma- hyper secretion of cortisol

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3
Q

S/S of Cushings

A 
central obesity: rapid weight gain w/ sparing of limbs (moon face, buffalo hump)
thinning of skin, striae, poor wound healing
muscle wasting
tachycardia; hypertension
osteoporosis
hyperglycemia/DM
Anti-inflammation/immunosuppresion
increased infection risk
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4
Q

tx for cushing’s

A

tumor removal
adrenalectomy
medications: if iatrogenic, decrease glucocorticoid

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5
Q

Second stage of RAAS system- at the lungs

A

lungs convert angiotensin I to angiotensin II w/ ACE

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6
Q

What happens in response to release of angiotensin II?

A

vasoconstriction of arteries
Increased aldosterone release from adrenal cortex– leads to increased blood volume through reabsorption. Ultimately leads to increase in blood pressure as needed

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7
Q

hyperaldosteronism

A

HTN, hypokalemia, hypernatremia, fatigue

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8
Q

Pheochromocytoma

A

tumor of adrenal medulla or extra-adrenal chromatin tissue- HTN, tachycardia, anxiety, panic attacks

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9
Q

common s/s of addison’s disease

A

hypotension, hypoglycemia, fatigue/muscle weakness, hyper pigmentation of skin, vomiting/diarrhea

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10
Q

cascade of thyroid function

A

hypothalamus–TRH—TSH—thyroid gland–release T3 and T4

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11
Q

function of thyroid hormone w/ role of calcium homeostasis

A

produces calcitonin in response to hypercalcemia- opposes parathyroid hormone

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12
Q

What happens when calcium levels in the blood are high? low?

A

high: calcitonin stimulates calcium salt deposit in bone
low: parathyroid glands release parathyroid hormone and to break down bone

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13
Q

target tissues of thyroid hormone?

A

CNS, heart, bones, liver

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14
Q

common s/s of hypothyroidism

A

lethargy/fatigue, poor muscle tone, brady cardia, weight gain, edema, cold intolerance, dry skin, goiter

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15
Q

types of hypothryoidism

A

primary: insufficient production of T3/T4
secondary: insufficient production of TSH
tertiary: insufficient production of TRH

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16
Q

s/s of hyperthryoidism

A

weight loss, increased appetite, anxiety, irritability, heat intolerance, fatigue, weakness, tremor, osteopenia, hyperglycemia

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17
Q

graves disease

A

autoimmune disease-overactive TSH receptor and increase thyroid hormone

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18
Q

thyroid storm

A

extreme of hyperthyroidism: stressors can bring it to the surface. s/s: severe tachycardia, dysrhythmias, sudden onset fever, flushing, fatigue, restlessness

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19
Q

3 functions of parathyroid hormone

A
  1. stimulates osteoclasts to release more Ca from bone
  2. decreases secretion of Ca by kidney
  3. activates vitamin D which simulates the uptake of Ca from the intestine
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20
Q

major risk factors for osteopenia

A 
history of fracture as an adult
fragility fracture in first degree relative
caucasian/asian postmenopausal woman
low body weight
current smoking
use of oral corticosteroids
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21
Q

bisphosphonates

A

slow down osteoclast activity- inhibits bone reabsorption by attaching to bony surfaces undergoing active reabsorption and inhibiting action of osteoclasts

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22
Q

two types of osteoporosis

A

1: postemenopausaul, hormone driven, cancellous bone, vertebral/colles fractures, age 50ish
2: both genders, age related after 70, cancellous and cortical bone, hip fractures, increased morbidity/ mortality

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23
Q

Definition of placebo

A

improvement in symptoms or condition due to expectations or sociomedical context in which a treatment takes place

  • -causal effect of a treatment context on outcome
  • -there is not one placebo effect, but multiple components/aspects of placebo effects
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24
Q

what are the two main contributions of neuroscience to placebo?

A
  1. mechanism: systems involved- pharmacology, systems, convergence
  2. intermediate markers- brain prices, stages of processing
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25
Q

key ingredients of placebo effects

A

social instruction
reinforcement (learning)
belief 9expectations)

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26
Q

2 factors effecting pain intensity

A
  1. social information

2. experienced based learning

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27
Q

what is the typical inter individual variability with placebo response?

A

non-responders and responders (some large response, some no response)

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28
Q

important aspects of enhancing treatment benefits

A

individualize treatment
give meaning
build trust
create hope and positive expectations

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29
Q

What is the juxtaposition of transplantation?

A

hoping for the best vs preparing for the worst

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30
Q

definition of transplant rejection

A

failure of immunosuppression medications to prevent activation of immune effector cells

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31
Q

common transplant postoperative issues

A
  1. psychologic issues: unfulfilled expectations, agitation, complications
  2. medical issues: anemia, hypertension, myopathy, osteoporosis
  3. exercise limitations: VO2 max~50-60% normal
  4. long term medical concerns post transplant: infection/rejection, renal failure
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32
Q

what is the most common diagnosis in adult heart transplants?

A

myopathy

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33
Q

NYHA classification HF

A

I-no limitations, any activity =7 METS
II- light limitations=5METS
III-moderate limitations

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34
Q

3 important things to remember about denervated heart

A
  1. heart rate is not a good monitor of work load during warm-up , cool-down or first five minutes of peak aerobic activity
  2. warm up is essential- needed for catecholamines to increase heart rate and 3. isometric exercise not well tolerated
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35
Q

how does a denervated heart increase CO?

A

rely on increases in SV through the Frank-starling mechanism and circulating catecholamine with activity

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36
Q

s/s of transplant rejection

A

fever, dysrhthmias, reduced contractility, increased dyspnea, decreased exercise tolerance.

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37
Q

what can chronic transplant rejection lead to?

A

vasculopathy- concentric wall thickening

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38
Q

contraindications to transplant

A 
smoking
extremes of weight
profound debility
osteoporosis leading to disability
psychosocial issues
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39
Q

main reason for lung transplants in adults and kids

A

adults: COPD
children: CF
* *people w/ CF must always have bilateral transplant

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40
Q

lung allocation score

A

0-100 score- higher score, higher priority

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41
Q

inpatient management of post lung transplant

A

ask issues, chest wall pain, limited inspiratory/expiratory volumes and flows

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42
Q

surgical approach for lung transplant options

A
  1. bilateral transverse thoracosternotomy
  2. thoracotomy
  3. median sternotomy
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43
Q

s/s of transplantation infection and rejection

A

fever/malaise/cough
decreased airflow
oxygen desaturation
decreased exercise capacity

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44
Q

acute vs chronic rejection

A

acute: biopsy- increase immunosuppression
chronic: >1 year bronchiolitis obliterates syndrome and worsening PFT– increase immunosuppression and/or retransplant

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45
Q

outcomes associated w/ physical therapy in transplant

A
  1. improved exercise capacity
  2. improves myopathy
  3. improved bone health
  4. improved health related quality of life
  5. changes in post op complications
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46
Q

HR, RR and BP full term neonate

A

110-160 bpm
RR= 30-40/min
75/50

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47
Q

full term neonate tidal volume

A

20 mL (adult is 500)

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48
Q

PaO2 and PaCO2 full term neonate and pH

A

O2=75-80
CO2=33
pH=7.33

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49
Q

what is different about heart pressures in fetal circulation?

A

feel heart pressures are opposite of postnatal pressures. Right heart > left heart due to a right to left shunt

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50
Q

wha are the three shunts present in fetal circulation?

A

Intracardiac
1. foramen ovale: allows blood to flow from right to left atrium
2. ductus arterioles: allows blood to flow from pulmonary artery to aorta, bypassing fetal lungs
extra cardiac
3. ductus venous: connects umbilical vein and inferior vena cava; bypassing portal circulation

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51
Q

important factors involved with fetal circulation

A
  • high pulmonary vascular resistance
  • low systemic vascular resistance
  • right to left shunt via PFO and DA
  • highly reactive to hypercapnia/acidosis
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52
Q

what occurs during the transition from neonate to newborn?

A

aeration and expansion of the lungs: rising paO2 leads to dilation of pulmonary arterioles and decreases PVR and decreases right heart pressures
removal of placenta circulation leads to increased left heart pressures and foramen oval closes- increases blood flow to lungs
-pressure in aorta increases

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53
Q

functions of the placenta

A

connects the developing fetus to the uterine wall to allow nutrient uptake, gas exchange, waste elimination, provides thermo-regulation to the fetus, fights against internal infection produces hormones to support pregnancy and acts as blood reservoir for fetus

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54
Q

when does foramen oval close?

A

as a newborn, about 2-3 months. Left heart pressure becomes greater than right
systemic vascular resistance >PVR

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55
Q

when does the ductus arterioles close?

A

functional closure~15-72 hours

anatomical ~2-3 weeks

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56
Q

what are common congenital heart defects?

A

PDA- patent ductus arterioles
PFO- patent foramen ovale
Atrial or ventricular septal defects (holes formed)

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57
Q

what happens in hypo plastic left heart syndrome?

A

right ventricle fails to develop. requires early surgical correction

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58
Q

what happens in tricuspid atresia

A

no tricuspid valve so blood cannot pass from RA to RV. Has opening between ventricles. Often staged reconstruction

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59
Q

coarctation of the aorta

A

aorta is narrowed, usually in the area where the ductus arterioles inserts. This increases LV work. If narrowing is after aortic arch, then strong pulse should be expected in UE and weak pulse in LE

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60
Q

what is the blood pressure differential in a coarctation of the aorta?

A

20 mmHg greater in UE than LE. This may also include differential cyanosis, headache, nosebleeds, leg cramps, LE weakness/cold

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61
Q

atrial septal defect

A

patent foramen oval- allows blood flow b/w right and left atria- may cause dysrhythmias, PPHN, HF

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62
Q

what does a patent ductus arterioles lead to?

A

allows ongoing communication b/w pulmonary trunk and descending aorta- left to right shunt develops if remains open and may predispose to heart failure

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63
Q

ventricular septal defect

A

abnormal communication b/w right and left chambers of heart- shunting depends on pressures- usually left to right. fast breathing, respiratory distress, poor feeding and poor weight gain.

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64
Q

tetralogy of fallot

A

4 defects of heart

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65
Q

general PT considerations w/ cardiac issues

A

frequently have reduced exercise capacity. Its w/ mild CHD allowed to participate in all competitive sports.
VO2 max normal increases into adolescence and adulthood.
Will present w/ increased HR rest and decreased HR max.

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66
Q

prevalence of respiratory illness in children

A

> 50% of all illnesses in children

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67
Q

what stage does surfactant begin to be produced?

A

at 24 weeks

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68
Q

how long is normal term?

A

40 weeks

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69
Q

how long do lungs continue to develop

A

8-10 years

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70
Q

what is the limit of viability?

A

gestational age at which a prematurely born fetus/infant has 50% chance of long term survival

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71
Q

what is the physiological significance of surfactant?

A

surfactant is a lipoprotein secreted by alveolar epithelium into the alveoli. Reduces surface tension to decrease WOB. Prevents collapse of small alveoli especially during expiration

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72
Q

difference in rib angle between newborn/adult

A

rib angle more horizontal in newborn than adult. Ribs orient obliquely with increased standing/walking at about 2 y/o

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73
Q

compliance in newborn chest wall

A

increased compliance- loss of mechanical efficiency w/ breathing

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74
Q

what happens to diaphragm w/ development

A

increased muscle growth and increased CSA, Increase % type I muscle fibers

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75
Q

thoraco-abdominal coupling

A

contracting chest wall muscle stabilize the infant rib cage. Minimizes inward displacement and encourages mechanical efficient.

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76
Q

clinical features of neonatal respiratory distress

A

substernal and intercostal retractions, nasal flaring, circumoral cyanosis.

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77
Q

differences between the child and adult lungs

A

decreased surface area for gas exchange, horizontal rib alignment, decreased compliance, increased RR, irregular respiratory pattern, diaphragm poorly developed, limited airway clearance abilities, increased WOB

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78
Q

infant respiratory distress syndrome

A

hyaline membrane disease- surfactant deficiency and lung inflammation leading to atelectasis, hypoxemia and decreased compliance. Often worsens over 2-4 days

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79
Q

bronchopulmonary dysplasia

A

often seen following IRDS. associated w/ need for prolonged mechanical vent and oxygen therapy. Usually hypercapnia and hypoxemia. inversely related to birthweight. Fibrotic changes resulting in reduced compliance.

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80
Q

meconium aspiration syndrome

A

meconium: early stool of infant. May be expelled prior to birth in amniotic fluid. Increases risk of fetal distress

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81
Q

congenital diaphragmatic hernia

A

developmental defect. will be cyanotic, dyspneic and tachycardia

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82
Q

cystic fibrosis

A

genetic alteration in chromosome leading to alterations in mucus hyper secretion and plugging combined w/ repeated infection.

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83
Q

why are CF kids not allowed to be together?

A

100% of patients w/ CF are colonized w/ some sort of bacteria

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84
Q

asthma s/s and classifications

A

intrinsic: non-allergic (10%)
extrinsic: mediated by allergic reaction
thickening of airway basement membranes. Edema and inflammation. Thick tenacious mucous in airways.

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85
Q

what should asthma action plans include?

A

modified exercise recommendations- school staff must have access to these.

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86
Q

precautions to take w/ patients w/ asthma

A
  1. ensure rescue medication is readily available
  2. ensure long warm-up and cool-down
  3. monitor environment for potential triggers
  4. permit student to monitor breathing status using a peak flow meter
  5. be aware of asthma action plan
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87
Q

green/yellow/red peak flow meter zone

A

green>80%: no modification required
yellow50-79%: have student take medication as directed and consider stop/start activities and moist environment
red 0-49%: stop activity and follow emergency asthma plan. Call 911 if not improved

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88
Q

PT considerations for pulmonary

A

airway clearance techniques integral part of pediatric lung disease. Consider pulmonary rehab approach and be aware of asthma action plan

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89
Q

3 forms of marijuana

A

single molecule pharmaceuticals
liquid extract: nabiximols
liquid extract: cannabidiol

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90
Q

where are endocannabinoid receptors found?

A

throughout the body: brain, organs, connective tissues, glands and immune cells. Goal is always homeostasis

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91
Q

targets of marijuana?

A

CB1 receptors and CB2 receptors

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92
Q

potential physiologic responses to cannabis

A

improves sleep, anti-seizure, reduces anxiety and psychotic symptoms, prevents nausea and stimulates appetite, reduces intraocular pressure, bronchodilator, relaxes muscles and reduces muscle spasms, relieves pain and anti-inflammatory

93
Q

common adverse side-effect of marijuana?

A

slowed reaction time, tachycardia, hypertension, coughing, wheezing, sputum production, lethargy, sedation, slowed reaction time, psychological dysfunction

94
Q

short term negative effects

A

impaired STM, impaired motor coordination, altered judgment, MVA, paranoia and psychosis

95
Q

effects of long term use

A

addiction, altered brain development, cognitive impairment, diminished life satisfaction, poor educational outcomes, symptoms of chronic bronchitis and psychosis

96
Q

MMJ vs opiod?

A

can be used in conjunction for greater cumulative pain relief and reductio opiate use. MMJ can prevent tolerance to opiates and potentially less dangerous

97
Q

most common reason for MMJ use in colorado

A

pain

98
Q

how should MMJ be studied?

A

meta-analysis and RCT

99
Q

federally, what is MMJ considered

A

a schedule I drug

100
Q

what part of MMJ is associated with psychoactive effects?

A

THC

101
Q

% of people w/ diabetes that will have a wound?

A

15%

102
Q

type 1 vs type 2 diabetes

A

type 1: cells that produce insulin are destroyed. results in insulin dependence. earlier onset
type 2: blood glucose levels high due to insulin resistance or lack of insulting production. Usually detected after 40 y/o

103
Q

fasting plasma glucose test values

A

normal:70-110
110-125 pre diabetic
>125 diabetic

104
Q

normal HbA1C

A

4-6.7%

105
Q

types of neuropathies

A
  1. motor: muscle weakness and changes in shape of foot. Caused by damage to large nerve fibers
  2. sensory: diminished sensation-lack of protective sensation caused by damage to small fibers
  3. autonomic: decreases sweat and oil production leading to dry, inelastic skin caused by damage to large fibers and sympathetic ganglion. Postural hypotension
106
Q

percentage of diabetics w/ neuropathy 20 years after diagnosis

A

50 symptomatic 40 asymptomatic

107
Q

how does diabetic neuropathy occur?

A

axonal thickening w/ progression to axonal loss
basement membrane thickening
decreased capillary blood flow to C fibers

108
Q

description of neuropathic wounds

A

occur on the foot- usually plantar surface or toes. Caused by mechanical forces or mine trauma. Occur in patients w/ diabetes, PVD or Hansen’sdue to peripheral neuropathies. Relieved w/ ambulation and usually architectural changes in foot. Pink, most, callus formation, plantar surface, skin usually warm, cellulitis. Usually w/ diabetes ro chemotherapy

109
Q

description of arterial wounds

A

caused by ischemia. usually located at peripheral extremities. Caused by macro or micro disease
often occurs w/ ambulation but has normal appearance of foot. Pale color, dry, hairless, cool to touch and history of PAD

110
Q

wagner scale

A

neuropathic wound classification w/ 0 being the best and 5 full foot gangrene

111
Q

ABI values

A

normal ,91-1.3
mild obstruction: .7-.9
moderate: .4-.69
severe: 1.3

112
Q

change in ankle pressure in patient w/ claudication

A

typically exhibit a >20 mmHg drop in pressure

113
Q

normal capillary refill?

A
114
Q

what does asymptomatic PAD still predict?

A

CAD and CVD

115
Q

at what point should exercise w/ PAD have a rest break?

A

moderate to severe claudication scale

116
Q

most common reason a foot ulcer in a patient w/ diabetes does NOT heal is

A

lack of pressure relief

117
Q

functions of the skin

A
  1. protection
  2. thermoregulation
  3. sensation
  4. metabolism
  5. aesthetics and communication
118
Q

layers of epidermis

A

stratum corner: protect
stratum lucid: adds thickness at “stress points”
stratum granulosum: transitional stage
stratum spinosum: made of cells that have spines
stratum basale: proliferative layer- regenerates the epidermis
basement membrane

119
Q

4 primary cell types

A
  1. keratinocytes: produce keratin and antibodies
  2. langerhans cells: part of immune system
  3. melanocytes: basal layer
  4. merkel cells: attached to sensory nerve endings
120
Q

dermis

A

thickest of 3 layers composed of collagen, elastin and ground substance. supplies oxygen and nutrients and stores much of body’s water supply. regulates temperature and contains blood vessels, lymph vessels, hair follicles, sweat glands, sebaceous glands, nerves

121
Q

layers of dermis

A
  1. papillary: body temp, nutrients, blood

2. reticular: composed of thicker network of collagen fibers- anchors skin to sub. cu.

122
Q

hypodermis

A

attaches dermis to bone/muscle. Composed of adipose, vessels, nerves. Shock absorption

123
Q

stages of wound healing

A
  1. hemostasis: stopping of blood
  2. inflammation: macrophages/cytokines
  3. proliferation (includes granulation and epithelialization): contractile cells help wound to shrink and epithelialize
  4. remodeling- change of type III collagen into type I (usually day 8-years)
124
Q

classification of wound by skin loss

A
  1. erosion- epidermis only
  2. partial thickness- loss of epidermis and part of dermis
    full thickness- loss of all epidermis, dermis and into subcutaneous tissue
125
Q

types of wound closure

A

primary intention: clean, straight line, edges approximated, rapid healing
secondary intention: larger wounds w/ tissue loss- edges not approximated, heals from inside out with longer healing time and larger scars
tertiary intention: delay is typically 3-5 days before the injury is sutured, used to manage infected or unhealthy wounds

126
Q

factors that impede wound healing

A

pressure, improper moisture, edema, infection, necrotic tissue, incontinence, age, oxygenation, disease, nutrition

127
Q

undermining

A

destruction of the connective tissue between the dermis and subcutaneous tissue

128
Q

fistula

A

tunneling that connects with a body cavity

129
Q

eschar

A

dead cells and fibrin- may be dry and hard or soft and rubbery. If stable and non-darning may choose to leave eschar in place

130
Q

slough

A

softer, lighter necrotic debris. By-product of autolysis. Usually beneath eschar. More common in inflammatory phase

131
Q

granulation tissue

A

red “beefy” looking. result of angiogenesis. Composed of new capillaries and extracellular matrix. Anemic to bright red. Necessary for closure by secondary intention

132
Q

adipose tissue

A

shy, yellow-white globules when health. is poorly vascularized and frequent sources of access formation

133
Q

sanguineous and serosanguineous

A

red, bloody and serous w/ pink tinge

134
Q

purulent

A

thick drainage, green, yellow, brown or white in color. infection is present

135
Q

serous

A

clear, watery

136
Q

types of passive drains

A

air or fluid moves from area of high pressure to one of lower pressure: penrose, gastrostomy, cystotomy, nephrostomy, t-tube

137
Q

examples of active drain

A

jackson-pratt, hemovac

138
Q

erythema

A

abnormal red color. May indicate underlying infection.

139
Q

cyanosis

A

dusky or bluish color. results from lack of oxygen

140
Q

petechia

A

small (1-2 mm) red or purple spot on skin

141
Q

purpura

A

> 3 mm

142
Q

eccymosis

A

> 1 cm; commonly called a bruise

143
Q

hemosiderin

A

brownish-purple color usually in gaiter area of leg. Results form red blood cell sin interstitial tissue. Usually begins distal and common in venous insufficiency

144
Q

definition of edema

A

excess fluid in the interstitial tissue. impedes healing

145
Q

definition lymphedema

A

diffuse, spongy edema. caused by obstruction w/ lymph system. may be pitting or indurated

146
Q

definition induration

A

hard, firm, swollen appearance. may be like orange peel. develops w/ chronic edema

147
Q

rolling wound edge

A

sign of a halted healing process. cells are termed senescent and unable to reproduce. rolled edge is termed epibole

148
Q

hyperkeratosis wound edge

A

overdevelopment of horny layer of the skin. appears as a callus or thickened skin

149
Q

what can type of pain tell you about wound?

A

deep-ischemia or hypoxia
throbbing/localized- infection
superficial tenderness- exposed nerve endings
pain w/ stimulation- living muscle

150
Q

what is considered protective sensation?

A

5.07 monofilament wire

151
Q

DIMES

A

debridement, infection/inflammation, moisture balance, edges, support

152
Q

characteristics of chronic wounds

A

necrotic tissue, bioburden, chronic inflammation, impaired hemodynamics, senescent fibroblasts, chronic wound fluid w/ growth inhibiting proteases, overgrowth of epithelium

153
Q

phases of PVD

A
  1. collateral circulation insufficient for metabolic needs- delayed healing of traumatic wounds
  2. claudication- pain w/ activity
  3. rest pain- requires revascularization surgery- may have ischemia of digits accompanying
154
Q

causes of chronic venous insufficiency

A

incompetent valves, obstruction (DVT), lack of venous pump activation w/ gait

155
Q

common skin changes consistent w/ diagnosing chronic venous insufficiency

A

hyper pigmentation, lipodermatosclerosis, dilated long saphenous vein, edema, dermatitis, thickened skin, cellulitis

156
Q

prevention of venous wound

A

compression, elevation, exercise, avoid prolonged sitting/standing, avoid crossing legs, skin lubrication

157
Q

another name for pressure ulcer

A

decubitus ulcer

158
Q

staging of wounds

A

1: sores are not open. skin may be painful/warm but no breaks or tears. reddened and does not blanch
2: skin breaks open- partial thickness
3: full thickness skin loss involving damage to underlying tissue. fat may be visible but not muscle tendon or bone
4: extensive tissue destruction including damage to muscle, bone or other structures

159
Q

causative factors of pressure ulcers

A

shear forces, friction forces, pressure forces, moisture

160
Q

friction vs. shear

A

fricton- mechanical force exerted when two surfaces move against another while shear is a stress resulting from applied forces which cause objects to deform- involves both friction and gravity

161
Q

what are the basic interventions expected from PTs for chronic wounds?

A

recognize, refer, and patient education. If involves arterial ulcer, remember gait training, footwear, education. Venous, remember COMPRESSION, diabetic- gait trainingg, footwear

162
Q

types of debridement

A
  1. selective: only necrotic. autolytic, enzymatic, biosurgical or sharp are all options
  2. non-selective- mechanical debridement- wet to dry
163
Q

3 questions for infection

A
  1. replicating bacteria? (culture), pain?, host reaction (systemic elevated WBC, fever, malaise)
164
Q

definition of contamination

A

no replicating bacteria, no pain, no host reaction

165
Q

definition of critically colonized?

A

yes replicating bacteria, yes pain, but no host reaction +1-2 clinical symptoms

166
Q

definition of infected

A

yes replicating bacteria, yes pain, yes dos reaction w/ >/=3 clinical symptoms- requires both topical and systemic antibiotics

167
Q

cellulitis

A

superficial tissue infection. dos not always begin from wound

168
Q

amount of time for healing stages

A

hemostasis: minutes
inflammatory: 3-5 days
proliferative 5 days-several weeks
remodeling: 21 days-years

169
Q

key signs to differentiate between inflammation and infection

A

infection will have severe pain possibly streaking, purulent drainage or copious amounts of clear drainage and pay attention to systemic symptoms

170
Q

cleansing?

A

non-infected: drinking water. antiseptic cleanser on infected wounds for 2 weeks. Ionic silver blocks respiratory cycle of bacteria and regulates inflammatory- used for mild local infection

171
Q

ways to add moisture vs ways to absorb

A

absorb: foam, hydrofiber, alginate (seaweed) skin barrier (protects from maceration) ADD: hydrogel, foam

172
Q

if ACE wrap used for compression, how should it be applied?

A

50% stretch with 50% overlap

173
Q

recommended compression for venous wound?

A

2 or 3 layer wraps, tubigrip, JOBST

174
Q

criteria for being admitted to burn department

A

burn injury >20% TBSA- high risk (face, hands, feet, perineum)

175
Q

survival rate from burn injuries?

A

96.8%

176
Q

what aspect of dermis must be in tact to allow for cell regeneration after burn?

A

dermal appendages

177
Q

time for healing in superficial thickness (epidermis only ) burn?

A

3-7 days- this is not included in TBSA%

178
Q

presentation of partial thickness burns?

A

blistered, weeping and bright red. Very painful. Usually takes 7-21 days to heal. Minimal to no scarring. Pigment change unlikely

179
Q

presentation of deep partial thickness burns?

A

pseudoexchar. Mottled white to pink. Epidermis, papillary and reticular dermis. 21-35 days healing. May develop severe hypertrophic scarring. White color indicates collagen

180
Q

presentation of full thickness burn

A

dry, leathery, charred. No pain. Hair pulls out easily. Skin grafting for healing. Epidermis, dermis to subcutaneous and beyond. No dermal appendages are left

181
Q

temporary coverage vs definitive coverage of burns

A

temporary: allograft
definitive: autograft

182
Q

causes of burn

A

thermal (scald, flame, friction)
electrical
chemical
radiation

183
Q

what should constantly be assessed in electrical burns?

A

asses motor and sensation- can get delayed neurological response

184
Q

rule of 9’s

A

9% for whole head, each arm (4.5 front and back), front of leg, back of leg, lower abdominal, chest, upper back, lower back

185
Q

most immediate life threatening response to injury after burn

A

hypovolemic shock: decreased bp, increased HR

186
Q

escharotomy

A

fluid accumulates in extracellular space- oscar acts as tourniquet- can lead to ischemic extremities and compartment syndrome- medical emergency

187
Q

nutritional support for burn injuries

A

caloric intake 24-45 kcal/kg

increased protein needs

188
Q

how often should someone splint for burn?

A 
new graft (0-5 days) all times
>5 days post op: when not in wound care or therapy
During scar/collagen remodeling: at rest
189
Q

MRC breathlessness scale

A

1-5 (5 too breathless to leave the house)

190
Q

5 commands for exam

A

1 open/close eyes

  1. look at me
  2. open your mouth and put out tongue
  3. nod your head
  4. raise your eyebrows when I have counted up to 5
191
Q

purpose of central venous catheters

A

used for monitoring pressure and medication administration. Pressure of right atrium.

192
Q

pulmonary artery catheter

A

monitors hemodynamic status

193
Q

arterial line/catheter

A

provides measurements of diastolic and mean arterial pressures continuously. Also a good way to assess respiratory status. Need to keep transducer at heart level

194
Q

definition of WOB

A

work of respiratory muscles to overcome the elastic and resistance factors from the airways, the lungs and the chest wall to expand the chest and lungs

195
Q

what type of ventilation is commonly used?

A

positive pressure ventilation= application of “super-atmospheric” pressure to the upper airway to initiate or perform inspiration

196
Q

CPAP

A

continuous positive airway pressure- pressure applied throughout inspiration/expiration to prevent airway collapse during expiration and promote easier inspiration

197
Q

reasons for high/low pressure w/ ventilation

A

high: mucus plug/bronchospasm/condensation
low: disonnection/tube leak

198
Q

speaking valve use?

A

be sure that the balloon is deflated before placing speaking valve. This allows patient to exhale air through mouth passing the vocal cords

199
Q

blood cell decision points?

A

hemoglobin >7 g/dl (>8-10 if known cardiovascular disease), hematocrit >25%, platelets >20,000, WBC if 10,000 consider active infection

200
Q

MRC scoring for muscle strength

A

0-no contraction

5- active movement against full resistance

201
Q

avoidant/restrictive food intake disorder

A

indifference to eating or food. rigidity and refusal to eat foods based on experience

202
Q

binge eating disorder

A

recurring episodes of eating significantly more food in a period of time than most people would eat- feelings of lack of control. Feelings of guilt or disgust

203
Q

eating disorder not otherwise specified

A

catch all term w/out firm diagnosis

204
Q

medical complications w/ AN-BP

A

sialadeuosis, pseudo-batter syndrome, electrolyte imbalance

205
Q

medical complications w/ both AN-BP and AN-R

A

lagophthalmos, refeeding syndrome, blood glucose imbalances, hepatitis, bone density loss

206
Q

sialadenosis

A

swelling of parotid glands- typically begins 3-4 days after cessation of purging

207
Q

pseudo-batter syndrome

A

dehydration: decreased K in urine, secondary hyperaldosteronism- causes body to retain salt and water. Seizures are a risk

208
Q

lagophthalmos

A

failure of eyelids to close fully due to sunken eyse

209
Q

GI complications common in AN-BP

A

GERD, Barrett’s esophagus, mallory weiss tears (small tear inside esophagus), boerhaave’s syndrome (hole in esophagus, painful yawn/pain behind sternum-EMERGENCY), cathartic colon, inert tube due to abuse of stimulant laxatives

210
Q

GI complications w/ AN-R

A

gastroparesis-delayed emptying, acute gastric dilation- requires NG tube, and superior mesenteric artery syndrome (duodenum becomes compressed between aorta dn SMA due to loss of fat pad)

211
Q

admission criteria for ACUTE

A

17 and older

typically

212
Q

goals for stay in acute?

A

2000-3000 kcal per day- sufficient to gain 2-3 lb/week
normalizing labs
complete refeeding
bowel function improvement
physically strong enough to transition to mental health setting

213
Q

hemophilia

A

group of hereditary bleeding disorders in which there is a deficiency of one of the factors necessary for coagulation of blood

214
Q

types of hemophilia

A

hemophilia A-deficiency of FVIII
hemophilia B- deficiency of FIX
von willebrands- vWHF is missing

215
Q

inheritance pattern of hemophilia

A

x-linked- male are affected, women are carriers. 20% of carrier women have decreased levels as well

216
Q

severity levels of hemophilia

A

sever=5% factor level

217
Q

common hemorrhages in hemophilia

A

soft tissue, muscle, going

218
Q

treatment of bleeding episodes

A

replace missing factor- given intravenously
RICE
bracing/splinting

219
Q

complications related to hemophilia

A

joint destruction
exposure to plasma viruses
inhibitor development- circulating antibody to factor

220
Q

why is orthopedic surgery useful in patients with hemophilia?

A

decreases the number of bleeding episodes
decreases pain
increases ROM
promotes independence

221
Q

joints commonly involved w/ hemophilia

A

knees, ankles, elbows, shoulders, hips

222
Q

factors of knee rehab in hemophilia

A 
avoid active movement first 24 hours
RICE
active hip/ankle exercises
splint
move within comfort range after 24 hours
NWB when blood is in the joint
223
Q

exercise progression w/ hemophilia

A

isometric, gentle active motion, progress to resistive (avoid over pressure w/ passive)

224
Q

how long does process of healing take for muscle injury?

A

20-40 days

225
Q

muscle rehabilitation w/ hemophilia

A

RICE and infusion therapy. Compression may be contra-indicated if risk of compartment syndrome
NWB gait
can use heat to warm muscle tissue
begin movement at one joint at a time

226
Q

definition of palliative care

A

patient and family centered. Optimizes quality of life by anticipating, preventing, and treating suffering throughout the continuum of illness. available concurrently w/ curative or life-prolonging care. Facilitates patient autonomy and choice

227
Q

what amount of healthcare expenditure do the sickest 10% account for?

A

2/3

228
Q

CARING criteria for palliative care

A 
C: cancer
A: 2 or more admissions for chronic illness in year
R: resident in nursing home
I: ICU w/ MOF
NG: non cancer hospice guidelines
229
Q

GAPS of palliative care

A

goals of care
advance directives
psycho-social spiritual support
symptoms

Medical Conditions (3 decks)

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