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Written PCE > Multisystem > Flashcards

Multisystem Flashcards

1
Q

What are some of the exercise precautions and contraindications for cancer patients?

A 
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
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2
Q

What are the safety guidelines for metastatic disease?

A

Follow protocols from MD (need WB order not just AAT)

Ask about any new neuro symptoms

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3
Q

What are the safety guidelines for anemia?

A

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

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4
Q

What are the safety guidelines for neutropenia?

A

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

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5
Q

What are the safety guidelines for thrombocytopenia?

A 
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
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6
Q

What are the 2 types of lymphedema?

A 
Primary = rare, inherited condition that development problems occur in lymph vessels
Secondary = d/t damage or obstruction to normally functioning lymph vessels or nodes
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7
Q

What are risk factors for lymphedema?

A

Radiation, axillary node dissection, arm infection/virus, weight gain since operation, obesity, older age

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8
Q

What conditions are patients with AIDS more susceptible to?

A

Pneumonia, TB, malignancy, encephalitis, meningitis, dementia, herpes zoster

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9
Q

What are some signs and symptoms of lupus erythematosus?

A
  • Butterfly rash
  • Localized erythema
  • Localized edema
  • Alopecia
  • Photosensitivity
  • Mucosal ulcers
  • Raynaud’s
  • Joint effusion
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10
Q

What is scleroderma and what can it cause?

A

Chronic disease primarily affecting skin, characterized by sclerosis = hardening of skin
Causes: joint contractures, pulmonary fibrosis, HTN, renal, GI dysmotility, Raynaud’s

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11
Q

Describe dermatomyositis and polymyositis and the difference between them.

A

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

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12
Q

What are 3 causes of haemophilia?

A

Vascular abnormalities, platelet abnormalities, coagulation cascade abnormalities

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13
Q

What are the 4 questions to ask for rheumatic disease?

A
  1. Red flags (#, septic, neuro signs, malignancy)
  2. Inflammation in joint or around joint - in joint will effect multiple ROM, no focal TOP, swelling common
  3. Focal (<3 joints) or widespread (>3 joints)
  4. Acute (<6wks) or chronic (>6wks)
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14
Q

What is the main feature of RA and what can it lead to?

A

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

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15
Q

What are the 7 RA criteria?

A

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

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16
Q

What are the components of joint count assessment for RA?

A

Joint effusion, joint line tenderness, stress pain

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17
Q

Hallux Valgus

A

RA
1st MTP synovitis, big toe is lateral, ligament laxity and erosion
Subluxation -> dislocation; prox phalanx drifts lateral

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18
Q

MTP Subluxation

A

RA
Displacement of flexors, unopposed extensors pull prox phalanx into hyperext, MT head prolapses and get dislocation and lateral drift of toes
Sign = callouses

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19
Q

Claw Toe

A

RA

MTP ext, PIP + DIP flex, often all toes except big toe

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20
Q

Hammer Toe

A

RA

Usually 2nd toe, flex PIP and hyperext DIP

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21
Q

Mallet Toe

A

RA

Flex DIP, affects long toe

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22
Q

Swan Neck

A

RA
Contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons
Flex MCP, hyperext PIP, flex DIP

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23
Q

Boutonniere

A

RA
Rupture of central tendinous slip of extensor hood
MCP ext, PIP flex, DIP hyperext

24
Q

Ulnar Drift

A

RA

Volar subluxation of MCP in radial collateral ligaments

25
Q

Dupytren’s Contracture

A

Contracture of the palmar fascia (MCPs and PIPs of 4th and 5th digits)

26
Q

Mallet Finger

A

Rupture or avulsion of extensor tendon at insertion into distal phalanx = DIP flex

27
Q

Gamekeeper’s Thumb

A

Sprain/rupture of UCL of MCP thumb

28
Q

What are 6 risk factors for OA?

A

Age, F>M, obesity, physical inactivity, injury, joint stress

29
Q

Describe the 2 types of FAI

A

Cam - bump on edge of femoral head (young men usually)

Pincer - abnormal acetabulum coverage of femoral head

30
Q

What are the characteristics of psoriatic arthritis? Describe the 2 types

A

Chronic, erosive, inflammation; affects digit joints, axial skeleton
Dactylitis - sausage like fingers d/t swelling
Enthesitis - usually in heels and back

31
Q

What 2 inflammatory conditions are related to enteropathic spondylitis?

A

Inflammatory bowel conditions = ulcerative colitis (lower half of bowels); Crohn’s disease (whole digestive system)

32
Q

What are the PT goals for ankylosing spondylitis?

A

Trunk flexibility, endurance, increase resp function

33
Q

What are the features of ankylosing spondylitis?

A

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

34
Q

What are the 7 clinical criteria for ankylosing spondylitis?

A 
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
35
Q

What are the contraindications for exercise in RA and OA?

A

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

36
Q

What are the precautions for exercise in RA and OA?

A

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

37
Q

Describe the S/S of hypoglycemia vs. hyperglycemia

A 
Hypo = dizzy, nausea, weak, sweating, fatigue, irritable, confusion, fainting
Hyper = blurred vision, fatigue, thirst, frequent urination, weakness, abnormal breathing, acetone breath
38
Q

What are the long term effects of diabetes?

A

Peripheral neuropathy, kidney failure, diabetic retinopathy, heart disease, infection

39
Q

What is sepsis and septic shock?

A

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

40
Q

Describe shock and its 4 types?

A

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

41
Q

What are 3 effects of diastasis recti?

A

Weak abdominal wall; dec support for back and viscera; related to lumbo-pelvic pain

42
Q

What are 6 causes of incontinence?

A

Injury to connective tissue; damage to pelvic nerves and muscles; direct injury to urinary tract; changes in pelvic floor anatomy; urethral weakness; vaginal relaxation

43
Q

Preeclampsia (what is it + s/s)

A

Pregnancy induced acute HTN after 24wks gestation

S/S: HTN, edema, headache, visual disturbance, hyperreflexia

44
Q

Describe the 3 degrees of burns.

A

1st - superficial, erythema appearance
2nd - partial thickness, blistering appearance
3rd - full thickness, necrosis, black and part of skin falling off

45
Q

What is the rule of 9s in burns?

A

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)

46
Q

Describe the 3 burn zones

A

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

47
Q

What are the modifiable and non modifiable risk factors for wounds?

A

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

48
Q

What are 4 causes of ulcers?

A

Pressure, shearing, friction, deep tissue damage from banging or bumping

49
Q

What are the 4 wound stages?

A

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

50
Q

What are the 5 cardinal signs of psoriasis?

A

Plaque, well circumscribed margins, bright salmon red colour, silvery micaceous scale, symmetrical distribution

51
Q

Describe the 2 types of eczema

A

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

52
Q

What are s/s of liver disease?

A

Yellow, itching, ascites, bleeding, esophageal varices

53
Q

Describe the difference between Grave’s Disease and Hashimoto Thyroiditis.

A 
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
54
Q

Addison’s Disease

A

Autoimmune process against the adrenal cortex (fatal if not treated)

55
Q

Cushing’s Disease

A

Chronic glucocorticoid (cortisol) excess = moon face, central obesity

Written PCE (7 decks)

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