Multisystem Flashcards
What are some of the exercise precautions and contraindications for cancer patients?
Precautions = swollen ankle, fatigue, vomiting and diarrhea, unexplained weight loss/gain, SOB with low level exertion Contraindications = racing pulse, fever, pain in back or neck or bone, calf pain, chest pain, nauseated while exercising, confused or disoriented, dizzy, faint, blurred vision, sudden SOB, very weak or tired
What are the safety guidelines for metastatic disease?
Follow protocols from MD (need WB order not just AAT)
Ask about any new neuro symptoms
What are the safety guidelines for anemia?
Normal Hb (14-18 in males; 12-16 in females)
Effects the amount of O2 carried to cells
Need to scale exercise back if below 8
What are the safety guidelines for neutropenia?
Dec WBC - relates to body’s ability to fight infection
Should be > 1000
Risk of infection if falls below 500
Avoid public areas for exercising and activities with inc exposure to viral/bacterial infection
Avoid exercise if have fever
What are the safety guidelines for thrombocytopenia?
Low platelet (normal = 150-400 000) Inc risk of bruising or bleeding Less than 50 000 = avoid activities with risk of contact or falls (low weights, stationary bike with no - low resistance, walking, ADLs) Less than 20 000 = inc risk of spontaneous bleed (doctor approval, AROM, walking, ADLs - may need supervision) Less than 10 000 = spontaneous GI, CNS, resp bleeding possible = no exercise, only essential ADLs, prevent falls and injury
What are the 2 types of lymphedema?
Primary = rare, inherited condition that development problems occur in lymph vessels Secondary = d/t damage or obstruction to normally functioning lymph vessels or nodes
What are risk factors for lymphedema?
Radiation, axillary node dissection, arm infection/virus, weight gain since operation, obesity, older age
What conditions are patients with AIDS more susceptible to?
Pneumonia, TB, malignancy, encephalitis, meningitis, dementia, herpes zoster
What are some signs and symptoms of lupus erythematosus?
- Butterfly rash
- Localized erythema
- Localized edema
- Alopecia
- Photosensitivity
- Mucosal ulcers
- Raynaud’s
- Joint effusion
What is scleroderma and what can it cause?
Chronic disease primarily affecting skin, characterized by sclerosis = hardening of skin
Causes: joint contractures, pulmonary fibrosis, HTN, renal, GI dysmotility, Raynaud’s
Describe dermatomyositis and polymyositis and the difference between them.
Inflammatory CT disorders characterized by proximal limb girdle weakness, often w/o pain
Dermato = affects skin and muscle - associated with photosensitive skin rash, purplish erythematous eruption over face, UE
Poly = muscle only
What are 3 causes of haemophilia?
Vascular abnormalities, platelet abnormalities, coagulation cascade abnormalities
What are the 4 questions to ask for rheumatic disease?
- Red flags (#, septic, neuro signs, malignancy)
- Inflammation in joint or around joint - in joint will effect multiple ROM, no focal TOP, swelling common
- Focal (<3 joints) or widespread (>3 joints)
- Acute (<6wks) or chronic (>6wks)
What is the main feature of RA and what can it lead to?
Synovitis (symmetrical pattern)
Leads to: immobility and consolidation (bones form single unit) of a joint, bones can become osteopenic, ligaments/tendons become damaged or ruptured, surrounding muscle deteriorates = joint instability and deformity prone
What are the 7 RA criteria?
Need 4+/7:
Morning stiffness >1hr (6wks); arthritis of >3joints (6wks); arthritis of hand joints; symmetric arthritis (6wks); rheumatoid nodules; serum rheumatoid factor; radiographic changes
What are the components of joint count assessment for RA?
Joint effusion, joint line tenderness, stress pain
Hallux Valgus
RA
1st MTP synovitis, big toe is lateral, ligament laxity and erosion
Subluxation -> dislocation; prox phalanx drifts lateral
MTP Subluxation
RA
Displacement of flexors, unopposed extensors pull prox phalanx into hyperext, MT head prolapses and get dislocation and lateral drift of toes
Sign = callouses
Claw Toe
RA
MTP ext, PIP + DIP flex, often all toes except big toe
Hammer Toe
RA
Usually 2nd toe, flex PIP and hyperext DIP
Mallet Toe
RA
Flex DIP, affects long toe
Swan Neck
RA
Contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons
Flex MCP, hyperext PIP, flex DIP
Boutonniere
RA
Rupture of central tendinous slip of extensor hood
MCP ext, PIP flex, DIP hyperext
Ulnar Drift
RA
Volar subluxation of MCP in radial collateral ligaments
Dupytren’s Contracture
Contracture of the palmar fascia (MCPs and PIPs of 4th and 5th digits)
Mallet Finger
Rupture or avulsion of extensor tendon at insertion into distal phalanx = DIP flex
Gamekeeper’s Thumb
Sprain/rupture of UCL of MCP thumb
What are 6 risk factors for OA?
Age, F>M, obesity, physical inactivity, injury, joint stress
Describe the 2 types of FAI
Cam - bump on edge of femoral head (young men usually)
Pincer - abnormal acetabulum coverage of femoral head
What are the characteristics of psoriatic arthritis? Describe the 2 types
Chronic, erosive, inflammation; affects digit joints, axial skeleton
Dactylitis - sausage like fingers d/t swelling
Enthesitis - usually in heels and back
What 2 inflammatory conditions are related to enteropathic spondylitis?
Inflammatory bowel conditions = ulcerative colitis (lower half of bowels); Crohn’s disease (whole digestive system)
What are the PT goals for ankylosing spondylitis?
Trunk flexibility, endurance, increase resp function
What are the features of ankylosing spondylitis?
MSK:
Sacroiliitis (hallmark) - SIJ inflammation
Enthesitis - inflammation of entheses (where tendon, ligs, capsule attach to bone) = bony erosion, overgrowth
Synovitis
Lungs: apical fibrosis, restrictive lung disease, avoid smoking
Heart: inflammation/scarring of conduction system, aorta
Eyes, bowels
What are the 7 clinical criteria for ankylosing spondylitis?
LBP + stiffness for more than 3 months AM stiffness Altered posture/muscle imbalances Dec strength Dec L spine ROM in sagittal and frontal plane Altered breathing mechanics Fatigue
What are the contraindications for exercise in RA and OA?
Inc pain, fatigue or AM stiffness; sudden pain at joint or joint deformity; joint becomes red, swollen and hot after doing exercise (24hrs); dec muscle strength and function; neuro s/s; SOB on mild exertion
What are the precautions for exercise in RA and OA?
Watch for inappropriate exercise - can harm joint
Swollen joints at risk for capsular stretch and rupture
OP bone at risk for #
Use machine and resistance band rather than free weights
Describe the S/S of hypoglycemia vs. hyperglycemia
Hypo = dizzy, nausea, weak, sweating, fatigue, irritable, confusion, fainting Hyper = blurred vision, fatigue, thirst, frequent urination, weakness, abnormal breathing, acetone breath
What are the long term effects of diabetes?
Peripheral neuropathy, kidney failure, diabetic retinopathy, heart disease, infection
What is sepsis and septic shock?
Whole body inflammatory state + presence of known or unknown infection
Shock = severe sepsis but hypoperfusion abnormalities despite adequate fluid resuscitation; immune system spirals; normal response to infection is local but then causes widespread vasodilation and vascular permeability
Describe shock and its 4 types?
Poor distribution of blood at microcirculation level; dec tissue perfusion = cell death
Hypovolemic - blood loss
Cardiogenic - heart damage
Distributive - hypotension and general tissue hypoxia
Obstructive - great vessels of heart, usually goes with cardiogenic
What are 3 effects of diastasis recti?
Weak abdominal wall; dec support for back and viscera; related to lumbo-pelvic pain
What are 6 causes of incontinence?
Injury to connective tissue; damage to pelvic nerves and muscles; direct injury to urinary tract; changes in pelvic floor anatomy; urethral weakness; vaginal relaxation
Preeclampsia (what is it + s/s)
Pregnancy induced acute HTN after 24wks gestation
S/S: HTN, edema, headache, visual disturbance, hyperreflexia
Describe the 3 degrees of burns.
1st - superficial, erythema appearance
2nd - partial thickness, blistering appearance
3rd - full thickness, necrosis, black and part of skin falling off
What is the rule of 9s in burns?
To determine body surface area involvement
Head = 9; torso = 36; each arm = 9; each leg = 18; pubic area = 1
(in kids torso and arms same but head is 18 and each leg 14)
Describe the 3 burn zones
Zone of coagulation - point of max damage, irreversible tissue loss
Zone of stasis - dec tissue perfusion, potentially salvageable
Zone of hyperemia - inc perfusion, will recover unless sepsis occurs
What are the modifiable and non modifiable risk factors for wounds?
Modifiable: autonomic dysreflexia, incontinence, smoking, obesity, poor nutrition, comorbidities, depression
Non-modifiable: dec sensation, activity and mobility, muscle atrophy, completeness of injury, age, hx of wounds, inc tissue temp, moisture, spasticity
What are 4 causes of ulcers?
Pressure, shearing, friction, deep tissue damage from banging or bumping
What are the 4 wound stages?
1 - reddened (non blanchable)
2 - skin is broken, small crater
3 - deep crater, might be infected, may be black, dead tissue
4 - deep through muscle to the bone or joint
What are the 5 cardinal signs of psoriasis?
Plaque, well circumscribed margins, bright salmon red colour, silvery micaceous scale, symmetrical distribution
Describe the 2 types of eczema
Atopic dermatitis - itchy inflammatory skin disorder associated with atopy (predisposition to developing certain allergic hypersensitivity); 3 phases: infantile (2mo-2yrs) - facial and extensor distribution; childhood - dry skin, flexural distribution; adult - improves with age, primarily affects hands
Contact Dermatitis - allergic = immune hypersensitivity to something in contact with skin; irritant = contact with something that causes local irritation
What are s/s of liver disease?
Yellow, itching, ascites, bleeding, esophageal varices
Describe the difference between Grave’s Disease and Hashimoto Thyroiditis.
Grave's = hyperthyroidism - stimulate thyroid = weight loss, goiter, tachycardia, bulging eyes, exercise intolerance Hashimoto = hypothyroidism - destruction of thyroid = weight gain, cold intolerance, bradycardia, round puffy face
Addison’s Disease
Autoimmune process against the adrenal cortex (fatal if not treated)
Cushing’s Disease
Chronic glucocorticoid (cortisol) excess = moon face, central obesity
