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PM&R Recap > Medical/General Rehab > Flashcards

Medical/General Rehab Flashcards

1
Q

When in the gait cycle is the center of gravity at its lowest point?

A

Loading phase

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2
Q

Where is the center of gravity located in gait cycle?

A

5cm anterior to S2 vertebrae

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3
Q

What are the six determinants of gait?

A

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

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4
Q

Cause of genu recurvatum?
Treatment options?

A

weak or overly spastic knee extensors
Spastic or tight plantar flexors

Swedish knee cage
Plantar flexor stretching/spasticity treatment

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5
Q

First muscles to weaken in Duchenne muscular dystrophy?

A

Neck muscles

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6
Q

What is the relationship between cardiac output, HR and stroke volume?

A

CO = HR x SV

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7
Q

Cardiac oxygen consumption?

A

Calculated using the rate-pressure product (RPP)
HR x SBP = cardiac O2 consumption (MVO2)

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8
Q

What scale allows patients to report their perceived level of challenge with an activity?

A

The Borg scale (6-20)

14-15 is a good level of exercise

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9
Q

What are the phases of cardiac rehabilitation?

A

Phase 1: inpatient phase
Phase 2: supervised outpatient phase (3-6 months)
Phase 3: less supervised outpatient phase
Phase 4: unsupervised outpatient, maintenance phase

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10
Q

Activity limitations for New York Heart Association (NYHA) Heart Failure 1?

A

can do anything over 7 METs
No real daily limitations or symptoms

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11
Q

Activity limitations for New York Heart Association (NYHA) Heart Failure 2?

A

Can do anything between 5-7 METs, dyspnea with more than a little activity

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12
Q

Activity limitations for New York Heart Association (NYHA) Heart Failure 3?

A

Can do anything between 2-5 METs
Dyspnea with the smallest activities

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13
Q

Activity limitations for New York Heart Association (NYHA) Heart Failure 4?

A

Can’t really do any activities with comfort
Dyspnea at rest

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14
Q

What are features of a new heart following orthotopic heart transplant (HR, peak HR?)?

A

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)

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15
Q

What are the patient benefits from pulmonary rehabilitation?

A

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)

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16
Q

What are the effects of aging on cardiac output, VO2 max, vital capacity, FEV1, muscle mass, # of motor units, swallow function?

A

All decline

With aerobic and strength conditioning - can increase cardiac output, Hgb, strength

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17
Q

What effect does aging have on fat metabolism/fat-soluble medication considerations?

A

Aging causes increased fat, careful with dosing with fat-soluble medications

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18
Q

Cancer pts most notably battle what symptoms?

A

fatigue, pain

Dysphagia also common

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19
Q

Common presentation of brain tumor?

A

HA

focal weakness, seizures

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20
Q

Common presentation of SCI tumor? Common location?

A

back pain worse at night
Thoracic extradural location

21
Q

Most common brain tumor in adults?

A

astrocytoma (often glioblastoma)

22
Q

Most common metastatic brain tumors?

A

lung, breast, GI

23
Q

Most common brain tumor in children?

A

cerebellar astrocytoma, medulloblastoma

24
Q

Most common primary osseous tumor?

A

osteosarcoma (usually knee)

25
Q

Most common metastatic osseous tumor?

A

lung, breast, prostate, multiple myeloma

*most are osteolytic, prostate CA is osteoblastic

26
Q

What is the recommended WHO cancer pain analgesic ladder for escalating pain meds?

A

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

27
Q

Most common pediatric cancer?

A

Leukemia

28
Q

Most common SOLID pediatric cancer?

A

Pilocytic astrocytoma, medulloblastoma, ependymoma most common

*posterior fossa tumors

29
Q

Most common pediatric peripheral soft tissue cancer?

A

Rhabdomyosarcoma

30
Q

Most common pediatric primary bone cancer?

A

Osteosarcoma (knee)

31
Q

What is the difference between induced transient myelopathy vs. delayed radiation myelopathy?

A

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

32
Q

Why are IV fluids administered to burn patients?

A

Once burned, histamine and prostaglandins cause local vasodilation with edema accumulation - IVF prevents hypovolemic shock

33
Q

Definition of a superficial partial thickness burn?

A

epidermis and part of dermis are damaged

34
Q

Definition of a partial thickness burn?

A

epidermis and most of dermis are damaged

35
Q

Definition of full-thickness burn?

A

epidermis and dermis are totally burned away

36
Q

Which burns must be hospitalized?

A

electrical, inhalation, fracture-related, medically complicated, facial or perineal burns

*Otherwise hospitalization depends on severity and amount of body surface area involved

37
Q

What is the rule of 9s for estimating total body surface area (BSA) burned?

A

Head = 9%
Each upper ext = 9%
each lower ext = 18%
anterior torsos = 18%
posterior torso = 18%
perineum = 1%

38
Q

What is optimal positioning to prevent contractures in burn patients?
Neck
Shoulder
Wrist
MCP
PIP/DIP
Hip
Knee
Ankle

A

Neck = extension
Shoulder = Abduction
Forearm = supination
Wrist = extension
MCP = flexion
PIP/DIP = extension
Hip = neutral
Knee = extension
Ankle = dorsiflexion

39
Q

Most common location for heterotopic ossification in burn patients?

A

Elbow

40
Q

How are rule of 9’s different in children?

A

Head = 18%
Legs = 14% each
Every year after 1yo, subtract 1% from head and add 0.5% to each leg

41
Q

At what rate does strength decline with bedrest?

A

Decreases by 1% each day

42
Q

Increased risk for renal stones in patients on bedrest is due to what?

A

Hypercalcemia - calcium is resorbed from the bones no longer performing weight-bearing activity

43
Q

What is osteomalacia?

A

Decreased bone mineralization (caused by Vit D deficiency)

44
Q

What is osteoporosis?

A

decreased bone mass leading to weak bones prone to fracture

45
Q

How is osteoporosis defined on DEXA?

A

T score < -2.5 on DEXA

46
Q

Risk factors for osteoporosis?

A

white female
Elderly
low BMI
Late menses
early menopause
smoking
EtOH
caffeine

47
Q

Common fracture sites for osteoporosis fragility fractures?

A

vertebral body compression fractures, hip fractures

48
Q

MOA of bisphosphonates?

A

decrease osteoclast bone resorption activity

SE: jaw osteonecrosis

PM&R Recap (10 decks)

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