Multisystem Conditions Flashcards
Male and female top cancers
Male: prostate, lung, colon
Female: breast, lung, colon
TMN cancer staging
0: carcinoma in situ
1-3: extend beyond where it has developed
4: spread to different organs
Chemotherapy side effects?
Alopecia, mucositis, pulmonary fibrosis, cardio toxicity, renal failure, sterility, myalgia, neuropathy
Radiation side effects
Skin irritation, scar tissue, hair loss, temp change in skin colour, Fatigue, swallowing discomfort
5 main treatments for cancer
Surgery Chemotherapy Radiation Hormone replacement sx Biological or genetic tx
Clinical presentation of patient with Cancer
- ROM limitation
- Fatigue
- Myalgia
- Arthralgia
- chemo induced peripheral neuropathy
- ## deconditioned
PT management of Cancer
- Fatigue management
- fxn and mobility management
- physical symptoms management
- psychological symptom management
Rehab: preventative, supportive, restorative
Acute sitting: mobility (equipment), strength, bed positioning
Exercise precautions for a cancer patient
Swollen ankle, fatigue, committing and diarrhea, unexplained weight loss/gain, SOB with low levels of exertion
Contraindications to exercise for Cancer patient
- racing pulse, fever, pain in back, neck, bones, calf pain, Chest pain, nauseated while exercising, confused or disorientated, dizzy/faint, blurred vision, sudden SOB, very weak and tired
If a person has Mets what Q’s need clarifying?
- Weight bearing orders (not just AAT)
- neurological symptoms ( b/b, pain)
Normal Hb levels for male and females
At what level does exercise need to be scaled back?
Male: 14-18 g/dl
Female: (12-16 g/dl)
Precaution when Hb is
What is the effect of Anemia?
Effects amount of O2 that can be carried to the cells
What is Neutropenia?
Decrease in WBC related to body’s ability to fight infection
Neutropenia: normal WBC #, point of infection risk.
Exercise precautions
Normal WBC >1000mcL
Infection risk increase if absolute neutrophils
Thrombocytopenia
- Low platelet count (normal = 150-400,000 mcL) increases bleeding/ bruising risk
Exercises dependent of platelet levels
If
What is the function of lymphatic system
Removal of fluids, proteins, bacteria, viruses
- smooth mm in walls contract to move lymph
Differentiate the two types of lymphodema
Primary:
- rare, inherited condition that development problems occur in lymph vessels
Secondary:
- D/T damage to or obstruction to normally functioning lymph vessels and nodes
Risk factors for Lymphedema
Radiation
- Axillary node dissection
- arm infection/virus (primary)
- wight gain since operation
- obesity (bmi >25)
- older age
How to measure Lymphedema
- circumferential (>2cm)
- water deplacement
- perometer and bioelectrical impedance
What are the goals of Palliative care, what can we help with?
Goal: comfort, support, maximize independence
Can aid with: respiratory, stress reduction, education
Ways that HIV AIDS is transmitted
- blood, saliva, semen, CSF, breast milk, vaginal secretions, mucous membrane, mother to child during pregnancy
Not by: urine, sweat, vomit
Common conditions associated with AIDS
Pneumonia, TB, malignancy, encephalitis, meningitis, dementia, herpes zoster
treatment for AIDS?
Med Rx:
- multiple antiviral therapy
- symptomatic tx: nutrition, functional mobility, education
PT management:
- mod aerobic & strength
- avoid exhaustion
- energy and stress management if acute
Pathology of autoimmune disorder Guillain-barre
Antibody mediated demyelination of Schwann cells in PNS from spinal nerves to terminating fibres
- possible hospitalization of 6-8 months
Cause: immune disorder (2/3 from recent illness)
GB s/s
- Rapid ascending motor weakness and distal sensory loss (starts in legs and spreads to arms, trunk, face)
- ataxia
- stocking and glove pattern of loss
- paralysis
- absent DTR
- may require ventilation
GB management
Medical: Plasmaphoresis, immunoglobin
PT:
- positioning to decrease ulcers
- joint protection
- chest Rx, mobilization
- strength
- ROM (opposite progression of ALS)
What is Lupus erythematosus?
A system autoimmune connective tissue disorder involving the skin and other systems ( kidney, CNS, Cardiac, pulmonary)
Lupus erythematosus s/s
- skin rash (butterfly)
- localized erythema
- localized edema
- arthritis
- alopecia
- photo sensitivity
- mucous ulcers
- Raynaud’s
- joint effusion
Dx: +ve serum “antinuclear antibodies” symmetric arthritis
What is Sclerodema (systemic sclerosis)
- Chronic disease primarily affecting skin, characterized by sclerosis (hardening of skin) via a massive fibrotic tissue response.
Can cause:
- joint contractures, pulmonary fibrosis, HTN
- renal, GI dysmotility (esp esophageal), Raynaud’s
Differentiate b/w Dermatomyositis and polymyositis
- Dermatomyotositis = skin+ muscle, photosensitive skin rashes, purplish erythematous eruption over face & UE
- Polymyositis = muscle only
- inflamed connective tissue disorder characterized by proximally limb girdle weakness, often without pain
What are 3 causes of hemophilia?
Hereditary bleeding disorder
1) vascular abnormalities
2) platelet abnormalities
3) coagulation cascade abnormalities
Discuss type A hemophilia?
- most common of hereditary clotting factor deficiencies
X-linked recessive = males have condition, females carry the gene
- if mom is carrier & father doesn’t: 50% chance male will have disorder, 50% female will be carrier
If mother is not carrier & father has hemophilia: male not affected/ can’t carry gene. Female child will be a carrier known as an Oblagate carrier
Hemophilia S/S?
1 = bleeding in the joint
- large bruises
- bleeding into muscles and joints
- prolonged blending after a cut
- big trauma = big organ bleed
S/S of patient with a joint bleed (hemophilia)
What can happen if not treated?
Stage 1) Joint tightness, no pain
2) tightness,pain , no bleeding
3) swollen hot to touch, hard to move joint
4) all ROM last + night splint
No Tx can lead to Arthritis
Tx= factor VIII infusion, desmopressin
Q’s to ask if querying a rheumatic disease?
1)Red flags:- #, septic arthritis, malignancy, central cord s/s, muscle weakness, burning/ numbness parasthesia
2) inflammation IN or AROUND joint?
- if in: effects multiple ROM, swelling is common, but no focal TOP
3) Focal or widespread?
4) Acute or chronic duration
Is the condition “inflammatory” or “non-inflammatory” via s/s?
Inflammatory:
- worse in AM, mod-severe swelling, occasional erythema, warmth, morning stiffness =/>1hr, systemic features sometimes present, frequent increase in ESR erythrocytes sedimentation rate [RA])
Non inflammatory:
- pain worse after use, mild swelling, not red, not warm, stiffness
Main feature of RA?
- pathology + leads to..
Synovitis (symmetrical pattern)
- synovium swells and cells proliferate:
1. Dense cellular membrane (pannus) spreads over articular cartilage
2. Erosion of bone and cartilage
3. w/ time pannus extends to opposite articular surface creating: 1) fibrous scar, 2) adhesions, 3) bony ankylosing
Leads to:
- immobility + consolidation of a joint
- bones become osteopenic
- ligaments/ tendons become damaged or ruptured
- mm deteriorating causing joint instability & deformity
Criteria for RA diagnosis?
- morning stiffness >1hr
- arthritis in >3 joints (6 weeks)
- arthritis in hands
- symmetrical arthritis
- rheumatoid nodules
- serum rheumatoid factors
- radiograph if changes
- abnormal antibody (HLA-DR4 [80% those w. RA])
HLA-DR4 also commonly found in pt with interstitial lung disease, hepatitis, pulmonary fibrosis,normal aging,
S/S of RA?
- pain, fatigue, stiffness (dec ROM), swelling, joint deformity, mm atrophy, extra cellular features.
How is RA managed?
MEDs:
- DMARDS/ Biologics to stop disease process
- Methotrexate to prevent permanent joint damage
- NSAIDs: Tylenol, cortisone = to dec inflammation and pain, help ROM
REHAB!
Lifestyle
Surgery
Discuss RA rehab?
Acute phase:
- energy conservation, ice, splints, gentle ROM (no stretching… May stretch the synovial membrane and cause irreversible damage)
Chronic phase:
- relieve pain: Heat/ice, modalities
- splints, exercise (ROM)
- relaxation/rest
- dec stiffness (ROM)
- endurance exercises (in water?)
- prevent deformity
- fall prevention
- physically active
4 R’s of sugery
Remove (MTP resection)
Re-align (tendon rupture)
Rest (arthrodesis)
Replace (arthroplasty)
Basics of a joint count Ax?
-indicator of RA disease activity via STOP method
- Joint effusion :2 or 4 finger technique
- Joint line tenderness
- Stress pain
Commonly affect joints in RA?
1) Atlanto-Axial joint:
- Transverse ligament: s/s = clunking in repositioning in sharp purser test, dysphagia, dizziness, blurred vision
2) TMJ: end stage = fusion of open bite
3) shoulder: humeral head migrates superior ply
4) AC joint
5) elbow: flexion deformity
- superior radio-ulnar joint involved= erosion of radial head
6) hip: groin pain, flexion deformity
7) knee: baker’s cyst, flexion deformity, valgus deformity, quad wasting
Classic RA Deformities
- Hallux valgus
- MTP subluxation
- Claw toe
- hammer toe
- mallet toe
- swan neck
- boutonnière
- ulnar drift
- Thumb: 90/90 or swan neck
- DRUJ instability
What is Hallux valgus? + effect on foot
1st MTP synovitis, big toe is lateral, lig laxity + erosion
- subluxation, dislocation leads to proximal phalanx drifting laterally causing pronation of mid foot
Discuss MTP subluxation
- Synovitis causing displacement of flexors, then unopposed extensors pull the proximal phalanx into hyperextension. Metatarsal head prolapsed and get dislocation and Lat drift of toes
Sign: callouses
What is claw toe?
MTP synovitis, MTP ext, PIP+DIP flexion
- often all toes except big toe
What is a hammer toes
- MTP & PIP synovitis (usually 2nd toe), leads to flexion of PIP and hyperextension of DIP (similar to boutonnière)
What is mallet toe?
Flexion of DIP (usually of longest toe)
