Medical/General Rehab Flashcards
When in the gait cycle is the center of gravity at its lowest point?
Loading phase
Where is the center of gravity located in gait cycle?
5cm anterior to S2 vertebrae
What are the six determinants of gait?
1) Pelvic tilt - pelvis on side of swinging leg (opposite to weight-bearing) is lowered 4.5 degrees to lower COG at midstance
2) Pelvic Rotation - pelvis rotates medially on swinging leg side, lengthens leg in prep to bear weight
3) Pelvic Lateral excursion - displacement toward the stance limb
4) Foot Mechanisms
5) Knee Mechanisms
6) Knee Flexion - early knee flexion at heel strike
Cause of genu recurvatum?
Treatment options?
weak or overly spastic knee extensors
Spastic or tight plantar flexors
Swedish knee cage
Plantar flexor stretching/spasticity treatment
First muscles to weaken in Duchenne muscular dystrophy?
Neck muscles
What is the relationship between cardiac output, HR and stroke volume?
CO = HR x SV
Cardiac oxygen consumption?
Calculated using the rate-pressure product (RPP)
HR x SBP = cardiac O2 consumption (MVO2)
What scale allows patients to report their perceived level of challenge with an activity?
The Borg scale (6-20)
14-15 is a good level of exercise
What are the phases of cardiac rehabilitation?
Phase 1: inpatient phase
Phase 2: supervised outpatient phase (3-6 months)
Phase 3: less supervised outpatient phase
Phase 4: unsupervised outpatient, maintenance phase
Activity limitations for New York Heart Association (NYHA) Heart Failure 1?
can do anything over 7 METs
No real daily limitations or symptoms
Activity limitations for New York Heart Association (NYHA) Heart Failure 2?
Can do anything between 5-7 METs, dyspnea with more than a little activity
Activity limitations for New York Heart Association (NYHA) Heart Failure 3?
Can do anything between 2-5 METs
Dyspnea with the smallest activities
Activity limitations for New York Heart Association (NYHA) Heart Failure 4?
Can’t really do any activities with comfort
Dyspnea at rest
What are features of a new heart following orthotopic heart transplant (HR, peak HR?)?
New heart is denervated, will have a higher resting HR (lack of vagal influence), lower peak HR, and early atherosclerotic disease (due to being foreign tissue and accelerated inflammatory response)
What are the patient benefits from pulmonary rehabilitation?
increase AVO2 difference - peripheral muscles become more conditioned; thus they take up more oxygen and increase the AVO2 difference (difference b/t O2 content of arterial blood vs. venous blood)
What are the effects of aging on cardiac output, VO2 max, vital capacity, FEV1, muscle mass, # of motor units, swallow function?
All decline
With aerobic and strength conditioning - can increase cardiac output, Hgb, strength
What effect does aging have on fat metabolism/fat-soluble medication considerations?
Aging causes increased fat, careful with dosing with fat-soluble medications
Cancer pts most notably battle what symptoms?
fatigue, pain
Dysphagia also common
Common presentation of brain tumor?
HA
focal weakness, seizures
Common presentation of SCI tumor? Common location?
back pain worse at night
Thoracic extradural location
Most common brain tumor in adults?
astrocytoma (often glioblastoma)
Most common metastatic brain tumors?
lung, breast, GI
Most common brain tumor in children?
cerebellar astrocytoma, medulloblastoma
Most common primary osseous tumor?
osteosarcoma (usually knee)
Most common metastatic osseous tumor?
lung, breast, prostate, multiple myeloma
*most are osteolytic, prostate CA is osteoblastic
What is the recommended WHO cancer pain analgesic ladder for escalating pain meds?
Step 1: non-opioids, adjuvants
Step 2: non-opioids, adjuvants, short-acting opioids
Step 3: non-opioids, adjuvants, long-acting/stronger opioids, short-acting opioids
Most common pediatric cancer?
Leukemia
Most common SOLID pediatric cancer?
Pilocytic astrocytoma, medulloblastoma, ependymoma most common
*posterior fossa tumors
Most common pediatric peripheral soft tissue cancer?
Rhabdomyosarcoma
Most common pediatric primary bone cancer?
Osteosarcoma (knee)
What is the difference between induced transient myelopathy vs. delayed radiation myelopathy?
induced transient myelopathy: develops several months after radiation, spinal cord sensory neurons are demyelinated
- patient recovers after several months
delayed radiation myelopathy: develops several months after radiation; sensory and bowel/bladder dysfunction occur
- permanent
Why are IV fluids administered to burn patients?
Once burned, histamine and prostaglandins cause local vasodilation with edema accumulation - IVF prevents hypovolemic shock
Definition of a superficial partial thickness burn?
epidermis and part of dermis are damaged
Definition of a partial thickness burn?
epidermis and most of dermis are damaged
Definition of full-thickness burn?
epidermis and dermis are totally burned away
Which burns must be hospitalized?
electrical, inhalation, fracture-related, medically complicated, facial or perineal burns
*Otherwise hospitalization depends on severity and amount of body surface area involved
What is the rule of 9s for estimating total body surface area (BSA) burned?
Head = 9%
Each upper ext = 9%
each lower ext = 18%
anterior torsos = 18%
posterior torso = 18%
perineum = 1%
What is optimal positioning to prevent contractures in burn patients?
Neck
Shoulder
Wrist
MCP
PIP/DIP
Hip
Knee
Ankle
Neck = extension
Shoulder = Abduction
Forearm = supination
Wrist = extension
MCP = flexion
PIP/DIP = extension
Hip = neutral
Knee = extension
Ankle = dorsiflexion
Most common location for heterotopic ossification in burn patients?
Elbow
How are rule of 9’s different in children?
Head = 18%
Legs = 14% each
Every year after 1yo, subtract 1% from head and add 0.5% to each leg
At what rate does strength decline with bedrest?
Decreases by 1% each day
Increased risk for renal stones in patients on bedrest is due to what?
Hypercalcemia - calcium is resorbed from the bones no longer performing weight-bearing activity
What is osteomalacia?
Decreased bone mineralization (caused by Vit D deficiency)
What is osteoporosis?
decreased bone mass leading to weak bones prone to fracture
How is osteoporosis defined on DEXA?
T score < -2.5 on DEXA
Risk factors for osteoporosis?
white female
Elderly
low BMI
Late menses
early menopause
smoking
EtOH
caffeine
Common fracture sites for osteoporosis fragility fractures?
vertebral body compression fractures, hip fractures
MOA of bisphosphonates?
decrease osteoclast bone resorption activity
SE: jaw osteonecrosis
