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PM&R > Med Rehab > Flashcards

Med Rehab Flashcards

1
Q

Benefits of pulm rehab?

A
  1. Improves exercise tolerance, work output, mech efficiency, symp-limited O2 consumption
  2. Increased AVO2 difference by increasing O2 extraction from arterial circulation
  3. Improved QOL, capacity to perform ADL’s
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2
Q

Ideal pulm rehab candidate?

A

Resp limitation of exercise at 75% predicted max O2 consumption;
Obstructive airway disease with FEV1 less than 2000 mL or FEV1/FVC less than 60%;
Restrictive lung disease with CO diffusion capacity less than 80% predicted

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3
Q

Moser classification

A
  1. Normal at rest
  2. Normal ADL performance (dyspnea on stairs/incline)
  3. Dyspnea with certain ADL’s (can walk 1 block at slow pace)
  4. Dependent with some ADLs; dyspnea with minimal exertion
  5. Dyspnea at rest
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4
Q

Definition of VO2 max? How to calculate?

A

Max volume of O2 that can be utilized in 1 minute during max or exhaustive exercise;
VO2max = (HR x SV) x AVO2 difference

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5
Q

Types of COPD

A

Chronic bronchitis;

Emphysema

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6
Q

For emphysema, what is only proven therapy to improve mortality in hypoxemic patients? What is the pathology in emphysema?

A

O2;

destruction of alveolar walls due to elastase; air spaces distended

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7
Q

For CF patients, what does aerobic exercise help with?

A

Increasing sputum expectoration

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8
Q

What predicted FEV1 would result in patient not having history of significant exercise impairment?

A

4 L or higher

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9
Q

Causes of restrictive pulmonary lung disease?

A

Instrinsic: Asbestosis, sarcoid, silicosis, IPF;
Extrinsic: DMD, ALS, GBS, MG, thoracic deformity, AS, cervical SCI

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10
Q

Respiratory complications with DMD?

A

Atelectasis 2/2 hypoventilation;

pneumonia

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11
Q

Normal rate of decrease in FEV1 is approx

A

30 ml/yr

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12
Q

For C5 tetraplegics, what happens with all lung volumes except RV?

A

Decrease;

RV is only one increasing

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13
Q

When appropriate to provide ventilatory support for DMD?

A

Dyspnea at rest;
45% predicted VC;
Max inspiratory pressure less than 30% predicted;
Hypercapnia

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14
Q

Best prognostic indicator for non-invasive ventilation in patients with ALS?

A

FVC

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15
Q

Young patients with moderate asthma not responding to beta-2 agonists, mast cell stabilizers, or leukotriene inhibitors could benefit from what?

A

Theophylline

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16
Q

Some benefits of home O2 use:

A
  1. Reduced polycythmia
  2. Improved pulm HTN
  3. Prolonged life expectancy
  4. Improvement in cognitive function
  5. Decreased BP and pulse in patients with COPD
  6. Reduction of perceived effort during exercise
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17
Q

Benefits of diaphragmatic breathing

A

Increased TV;
decreased FRC;
increased max O2 uptake

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18
Q

Benefits of pursed-lip breathing

A

Prevents air trapping due to small airway collapse during exhalation;
promotes greater gas exchange in alveoli;
increases TV;
reduces work of breathing in COPD

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19
Q

What happens to dependent alveoli when changing from sitting to supine position?

A

Expand in size, with increased ventilation at base of the lung

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20
Q

Of three zones of lung, what is relationship of ventilation to perfusion?

A

Zone 1 (apex): Ventilation occurs in excess of perfusion;
Zone 2: Perfusion and ventilation are fairly equal;
Zone 3: Pulmonary artery pressure > pulm venous pressure > alveolar pressure

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21
Q

When changing from sitting to supine position, what happens to venous pressure relative to arterial pressure?

A

Increases

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22
Q

Particular advantages to pre-op and post-op chest therapy program?

A
  1. Decrease pneumonia incidence

2. Reduce prob of developing post-op atelectasis after thoracic/abdo surg

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23
Q

Benefits for CF patients in structured running program?

A 
Improvements in 
1. Exercise capacity
2. Respiratory muscle endurance
3. Reduction in airway resistance;
in kids, can see improved lung function, increased sputum expectoration
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24
Q

Uses of glossopharyngeal breathing

A
  1. Pt breathes w/o mechanical ventilation
  2. Improve volume of voice and rhythm of speech
  3. Prevent microatelectasis
  4. Patient can take deeper breaths for more effective cough
  5. Improve or maintain pulm compliance
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25
Q

Example of positive-pressure body ventilator to help with ventilation?

A

Intermittent abdo pressure ventilator (IAPV); eg pneumobelt, exsufflation belt

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26
Q

Example of negative- and positive-pressure body ventilator?

A

Rocking bed

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27
Q

Preferred method to treat OSA?

A

CPAP

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28
Q

When is a fenestrated trach tube useful?

A

Patients able to speak and require only intermittent ventilatory assistance

29
Q

Why use non-fenestrated tubes? What if the patient wants to talk?

A

If pt requires continuous mech ventilation or unable to protect airway during swallowing;
if pt wants to talk, can use one-way talking valve

30
Q

Why use a talking trach tube?

A
  1. Alert and motivated patient
  2. Needs inflated cuff for ventilation
  3. Intact vocal cords and ability to mouth words
31
Q

When to use one-way speaking valve (e.g. Passy-Muir valve?)

A
  1. Alert, awake, trying to communicate
  2. Medically stable, can exhale efficiently and completely around trach tube
  3. Can tolerate complete cuff deflation
  4. Able to tolerate speaking valve trial
32
Q

What occurs with speaking valve trial?

A

Cuff must be completely deflated when Passy-Muir valve is on;
if unable to deflate this can lead to immediate respiratory distress. Ideally have uncuffed trach tube

33
Q

Three phases of cardiac rehab? Which is the most closely monitored phase?

A
  1. Acute inpatient hospitalization
  2. Supervised outpatient cards rehab lasting 3-6 mos
    3/4: Intermediate and maintenance phase;
    phase 2
34
Q

How to calculate RPP? VO2 max?

A 
RPP = HR x SBP;
VO2max = CO x AVO2 difference
35
Q

Cards rehab health professionals use graded exercise testing as _______ rather than ______ tools

A

functional; diagnostic

36
Q

For exercise testing protocols, what can LE amputee patients use? What is a more common form of physiologic test?

A

Arm ergometer;

treadmill test

37
Q

Bruce Protocol of ____ to _____ METs per stage is useful with stable patients with functional capacities of ____ METs

A

2; 3;

10

38
Q

METs for sexual intercourse?

A

3-4

39
Q

To maintain comprehensive physical fitness, what is recommended duration and freq of exercise? Target MET-minutes per week?

A

Mod cardiorespiratory exercise for 30 mins or more 5 or more days a week;
Vigorous cardioresp exercise 20 mins or more for 5 or more days a week;
500-1000 MET minutes per week

40
Q

What is more common, orthotopic or heterotopic hearttransplantation?

A

Orthotopic

41
Q

Some physiologic responses after heart transplant?

A
  1. Resting tachy 100-110 bpm
  2. Lower peak HR
  3. Resting HTN common
  4. Slower return to resting HR post-exercise
  5. Work capacity, CO, SBP, VO2 lower
42
Q

How does exercise improve PAD and walking economy?

A

Increase biomechanical and metabolic efficiency

43
Q

Increase in energy for unilateral BK vs. b/l BK with prosthesis?

A

9-28;

41-100

44
Q

Increase in energy for unilateral AKA with prosthesis vs b/l AKA?

A

40-65;

280

45
Q

Increase in energy for unilateral BK plus contralateral AKA with prostheses?
Unilateral hip disartic with prosthesis?
Hemipelvectomy with prosthesis?

A

75;
82;
125

46
Q

How are physical exertion requirements defined?

A

Sedentary: lift no more than 10 lb, walking/standing occasional;
Light: Lifting no more than 20 lbs. Fair amount of walking/standing;
Medium: Lift no more than 50 lbs and freq carrying up to 25 lbs;
Heavy: Lift no more than 100 lb and freq carrying up to 50 lb;
Very heavy: Lifting more than 100 lb and carrying more than 50 lb

47
Q

Most common rehab problems for patient with cancer described as follows:

A
  1. General weakness
  2. ADL deficits
  3. Pain
  4. Difficulty with ambulation
48
Q

Most common primary brain tumors in kids?

A
  1. Cerebellar astrocytoma

2. Medulloblastoma

49
Q

Most common symp and sign of brain tumors? Best diagnostic test?

A

Headache;
weakness;
contrast MRI

50
Q

Most common form of radiation damage?

A

Induced transient myelopathy; can see this in posterior columns and lateral spinothalamic tract

51
Q

Unlike induced transient myelopathy, delayed radiation myelopathy is

A

irreversible

52
Q

Vincristine can cause distal _____ degen

A

axonal

53
Q

Rad plex usually involves ______ trunk; tumor affecting more _____ trunk

A

upper;

lower

54
Q

Some common SE’s of radiation therapy?

A

Cognitive effects, fibrosis, contractures

55
Q

Carcinomatous myopathy seen in

A

metastatic disease; see muscle necrosis and prox muscle weakness

56
Q

Carcinomatous neuropathy affects

A

peripheral nerves and muscle;

see distal motor and sens loss, prox muscle weakness, decreased sensation and reflexes

57
Q

UE lymphedema most common after _____ cancer; when do you see LE lymphedema?

A

breast cancer;
uterine disorders, prostate cancer, lymphoma, melanoma

PLUM

58
Q

Stages of lymphedema

A 
Stage 0: No edema, maybe heavy limb;
Stage 1 (spontaneously reversible): Non-pitting edema, swelling may be reversible;
Stage 2 (spontaneously irreversible): Pitting edema, see fibrosis;
Stage 3 (lymphostatic elephantiasis): Very large edema, swelling irreversible
59
Q

Lymphedema grading

A 
Grade 1 (mild): pitting edema that is reversible with elevation of extremity;
grade 2 (moderate): non-pitting, brawny edema not reversible with elevation;
Grade 3a (severe): edema minimally reversible or not reversible;
Grade 3b (massive edema): affects two or more extremities;
Grade 4 (elephantiasis)
60
Q

In patient with metastatic bone involvement, pain most severe

A

at night or upon weight bearing

61
Q

Risk of pathologic fx correlates with what?

A
  1. Extent of lesion
  2. Type of destruction
  3. Anatomic location
62
Q

What cancers have predilection to metastasize to bone?

A

Breast; lung; thyroid; kidney, prostate

BLT with a Kosher Pickle

63
Q

Over 90% of UE mets involve ______; most mets of LE involve _____ and ______

A

humerus;

hip and femur

64
Q

Tumors that can lead to lytic lesions?

A
  1. Myeloma
  2. Lung
  3. Kidney
  4. Thyroid
  5. Malignant lymphoma
  6. Breast

BLT for MLK

65
Q

Tumors that can lead to blastic lesions?

A
  1. Prostate

2. Metastatic breast

66
Q

Most common primary malignant bone tumor in children is

A

osteosarcoma

67
Q

Of the NSAIDs, what has least incidence of thrombocytopenia?

A

Ketorolac

68
Q

WHO ladder

A

Step 1: mild pain, non-opioid analgesics and adjuvants;
Step 2: moderate pain, weak opioids with non-opioids and adjuvants;
Step 3: severe pain, stronger opioids with non-opioids and analgesics;
Step 4: refractory pain: other therapies like parenteral opioids, nerve blocks, RFA’s, vertebroplasty

PM&R (12 decks)

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