Multisystem Conditions Flashcards
1
Q
__ in 5 Canadians will get cancer, __ in 4 will die from cancer
A
2;1
2
Q
Top 3 cancers in males?
A
- prostate
- lung
- colon
3
Q
Top 3 cancers in females?
A
- breast
- lung
- colon
4
Q
Top 3 cancer mortality male?
A
- lung
- colorectal
- prostrate
5
Q
Top 3 cancer mortality female?
A
- lung
- breast
- colon
6
Q
TMN cancer staging system?
A
T = tumour (Tx, T0, T1-4) N = nodes (lymph) - Nx, N0, N1-3 M = mets (distant ones) - Mx,M0, M1
7
Q
Cancer stages?
A
0 - 4
8
Q
Stage __ cancer = in situ
A
0
9
Q
Stage __ - __ cancer = cancer has extended beyond organs in which it first developed
A
1-3
10
Q
Stage __ cancer = cancer has spread to different organs
A
4
11
Q
5 possible Rx for cancer ?
A
- Sx
- chemo
- radiation
- hormone replacement therapy
- biological or genetic Rx to destroy ca cells
12
Q
Name 5 side effects of chemo
A
any of…
1) alopecia
2) mucositis
3) pulmonary fibrosis
4) cardiotoxicity
5) renal failure
6) sterility
7) myalgia
8) neuropathy
13
Q
Name 5 side effects of radiation
A
any of…
1) FATIGUE
2) skin irritation
3) scar tissue
4) hair loss
5) temporary change in skin colour
6) swallowing discomfort
14
Q
4 PT Rx for cancer
A
- fatigue management
- function and mobility management
- physical symptom management
- psychological symptom management
15
Q
Exercise precautions for ca pts? (5)
A
- swollen ankle
- fatigue
- vomiting / diarrhea
- unexplained weight loss or gain
- SOB w/ low level of exertion
16
Q
Exercise CI’s for ca pts? (9)
A
- racing pulse
- fever
- pain in back or neck, or bone, calf pain and chest pain
- nauseated while exercising
- confused or disoriented
- dizzy or faint
- blurred vision
- sudden SOB
- very weak or tired
17
Q
For metastatic disease, you need ____ ______ orders from MD!
A
weight bearing (cannot just have AAT!)
18
Q
Metastatic disease pts: ask about any new _______ symptoms
A
neurological (B/B, unrelenting pain)
19
Q
Normal Hb levels males = __ - __ g/dl
A
14-18
20
Q
Normal Hb levels females = __ - __ g/dl
A
12-16
21
Q
Anemia: exercise will need to be scaled back if below __ g/Dl
A
8
22
Q
_________ = decreased WBC
A
neutropenia
23
Q
WBC count should be > ____ mcl
A
1000
24
Q
Risk of infection if absolute neutrophils falls below ____ MCL
A
500
25
Neutropenia: avoid exercise if pt has fever > ___
37.5
26
_________ = low platelet count
thrombocytopenia
27
Normal platelet count = __ - ______ /mcl
150-400,000
28
Thrombocytopenia: if < _____ MCL = avoid any activities w/ contact or risk of falling
50,000
29
Thrombocytopenia: Rx b/w __ - ____ MCL = low weights, stationary bike LOW resistance, walking or ALDs
40-60000
30
Thrombocytopenia: Rx b/w __ - _____ mcl = low intensity exercise, low weights, stationary bike NO resistance or minimal, walking and ADLs
20-40000
31
Thrombocytopenia: if < _______ = risk of spontaneous bleed unrelated to trauma
20000
32
Thrombocytopenia: Rx b/w __ - ______ mcl = doctor approval, active ROM exercises, walking, ADLs
10-20000
33
Thrombocytopenia: if below ________ = spontaneous CNS, GI or resp bleed; no exercise, only essential ADLs, prevent falls and injury
10,000
34
_______ lymphedema = rare, inherited condition where developmental problems occur in lymph vessels
primary
35
______ lymphedema = D/T damage or obstruction to normally functional lymph vessels and nodes
secondary
36
6 risk factors for lymphedema ?
1. radiation
2. axillary node dissection
3. arm infection / virus
4. weight gain since operation
5. obesity (BMI > 25)
6. older age
37
4 things to do to prevent lymphedema?
1. skin care
2. activity / lifestyle
3. avoid limb constriction
4. avoid extreme temp
38
Measuring lymphedema: > __ cm difference between size indicates lymphedema
2
39
3 ways to measure lymphedema?
1. circumferential
2. water displacement
3. perometer and bioelectrical impedance
40
HIV can be transmitted through urine, sweat and vomit (T/F)
FALSE
41
Result of AIDS = loss of immune system function, decrease in ____ helper T cells
CD4+
42
3 ways to Dx AIDS?
1. clinical findings
2. systemic evidence
3. lab evidence
43
Lab evidence HIV: HIV-1 ______ test, CD4 cell count __ - ___ / ml
antibody; 200-500
44
Normal CD4 cell count?
b/w 800-1200
45
HIV: want to keep viral ____ as low as possible
load
46
Med Rx for HIV?
1. multidrug antiviral therapy
| 2. symptomatic treatment
47
_______ = antibody mediated demyelination of schwann cells in PNS from spinal nerves --> terminating fibers
GBS
48
GBS: __/3 people had recent illness in last 30 days
2
49
4 S/S of GBS?
1. onset to peak 4 weeks
2. rapid ascending motor weakness and distal sensory loss
3. stocking and glove pattern of loss
4. absent DTR!
50
5 PT rx for GBS?
1. positioning
2. joint protection
3. chest Rx, mobilization
4. strength
5. ROM
51
GBS trajectory is usually opposite to what other disorder?
ALS!
52
______ ______ = can involve skin and other multi system (organs, arthritis, etc)
lupus erythematous
53
8 S/S of lupus erythematous?
1. skin (butterfly rash)
2. localized erythema
3. localized edema
4. alopecia
5. photosensitivity
6. mucusal ulcers
7. Raynauds
8. joint effusion
54
Lupus erythematous = may see _____ (malar) rash
butterfly
55
Dx of lupus erythematous?
+ve serum antinuclear antibodies (ANA), symmetric arthritis
56
_______ = chronic disease primarily affecting skin, characterized by sclerosis
scleroderma
57
Scleroderma provokes massive ______ tissue response
fibrotic
58
Name 6 side multi system side effects caused by scleroderma
1. joint contractures
2. pulmonary fibrosis
3. HTN
4. renal side effects
5. GI dysmotility
6. Raynauds
59
Dermatomyositis / polymyositis = inflammatory CT disorder characterized by _______ limb girdle weakness
proximal
60
Dermatomyositis affects skin, and polymyositis affects muscles (T/F)
FALSE; dermatomyositis affects both skin and muscles!
61
_______ = hereditary bleeding disorder; body unable to control blood clotting / coagulation
haemophilia
62
Type __ haemophilia = most common of hereditary clotting factor deficiencies
A
63
Type A haemophilia = __ linked recessive ; males have condition, females carry gene
X
64
If father has haemophilia, mother doesn't carry gene: male child (can/cannot) carry gene; female child = ______ carrier
CANNOT; obligate
65
Most common problem w/ haemophilia ?
bleeding into joints !
66
Haemophilia: joint bleeding symptoms ?
1. joint tightness + no pain
2. tightness + pain
3. swollen, hot to touch, hard to move
4. all ROM lost + severe pain
5. bleeding slows in few days b/c joint is full of blood
67
If haemophilia / joint bleeds are not treated will cause disabling ______
arthritis
68
2 Rx for haemophilia ?
1. recombinant factor VIII infusion
| 2. dismopressin (mild hemophila)
69
Red flags in rheumatic diseases? (6)
1. #
2. septic arthritis
3. malignancy
4. central cord S/S
5. focal/diffuse muscle weakness
6. burning / numbness paresthesia
70
4 questions to ask in rheumatic diseases?
1. red flags
2. inflammation in joint or around joint
3. focal or widespread
4. acute or chronic
71
If inflammation is (in/around) joint, it will effect multiple ROM, no focal TOP, swelling common
IN
72
Focal arthritis = < __ joints, widespread = > __ joints
3;3
73
Acute arthritis = < __ weeks, chronic = > ___ weeks
6
74
Inflammatory condition = when is pain worst? Non inflammatory ?
AM; after use
75
Swelling in inflammatory conditions ?
moderate to severe
76
Swelling in non-inflammatory conditions ?
mild
77
Is there warmth in inflammatory conditions? Non inflammatory ?
sometimes; no
78
Inflammatory conditions = morning stiffness > __ hour; non inflammatory conditions = morning stiffness < __ minutes
1; 30
79
Inflammatory conditions = often increased in _____
ESR
80
______ features are often present in inflammatory conditions, absent in non inflammatory conditions
SYSTEMIC
81
Example inflammatory condition? Non inflammatory condition ?
RA; OA
82
Main feature of RA = _______
synovitis
83
RA = ______ pattern
symmetrical
84
RA: dense cellular membrane (_______) spreads over articular cartilage
pannus
85
RA: _____ erodes underlying cartilage and bone
pannus
86
RA: w/ time, pannus may extend to the opposite articular surface creating what 3 things?
1. fibrous scar tissue
2. adhesions
3. bony ankylosing
87
8 RA criteria?
1. morning stiffness > 1 hour (6 weeks)
2. arthritis of >/= 3 joints (6 weeks)
3. arthritis of hands
4. symmetric arthritis (6 weeks)
5. rheumatoid nodules
6. serum rheumatoid factor
7. radiographic changes
8. abnormal antibody (80% in those w/ RA)
88
What is the abnormal antibody found in pts with RA?
HLA-DR4
89
5 other conditions besides RA HLA - DR4 is found in ?
1. ILD
2. chronic hepatitis
3. IPF
4. normal aging adults
5. SLE
90
3 things that increase risk of RA?
1. giving birth
2. cigarette smoke
3. pollution
91
7 S/S of RA?
1. pain
2. fatigue
3. stiffness
4. swelling
5. joint deformity
6. mm atrophy
7. extra-articular features
92
Meds for RA (3 groups)?
1. DMARDS / biologics
2. methotrexate
3. NSAIDS, tylenol, cortisone
93
______/ _____ stope the RA disease process
DMARDs / biologics
94
________ prevents permanent joint damage / premature death from RA
methotrexate
95
RA: With ______ , it is important to educate your pt on effects on liver and reproductive organs
methotrexate
96
NSAIDS, tylenol and cortisone do not stop RA disease process but improve inflammation and pain, but not ROM (T/F)
FASLE - DO improve RIM
97
RA rehab in ______ phase = energy conservation, ice, splints, gentle ROM
acute
98
RA rehab acute phase: NO _______ !
stretching
99
Name 5 rehab goals for RA chronic phase.
Any of...
1. relieve pain
2. splints, exercise (gentle ROM)
3. relaxation / rest
4. dec stiffness (gentle ROM)
5. aquatic exercise
6. functional exercises
7. prevent deformity
8. fall prevention
9. moderate intensity PA
100
4 R's of surgical management of RA?
1. remove (MTP resection
2. re-align (tendon rupture)
3. rest (arthrodesis)
4. replace (arthroplasty)
101
Name the 3 steps in a joint count assessment.
STOP!
1. joint effusion (2 or 4 finger technique)
2. joint line tenderness
3. stress pain
102
Name 7 commonly affected joints in RA
1. AA joint
2. TMJJ
3. GHJ
4. AC joint
5. elbow
6. hip
7. knee
103
Elbow in RA: superior ______ joint commonly involved, leading to erosion of ______ head
radioulnar; radial
104
RA: ______ ligament may be affected at AA joint
transverse
105
RA: humeral head may move _______ at GHJ
superiorly
106
_____ _____ = 1st MTP synovitis, big toe is lateral, ligament laxity and erosion
hallux valgus
107
Hallux valgus: subluxation --> dislocation, proximal phalanx drifts _______, causing _______ of mid foot
laterally; pronation
108
______ ________ = synovitis, displacement of the flexors, unopposed extensors pull the proximal phalanx into hyperextension
MTP subluxation
109
MTP subluxation: MT heads prolapse and get dislocation and _______ drift of toes
lateral
110
Sign of MTP subluxation?
callouses
111
______ _____ = MTP synovitis. MTP ext, PIP + DIP flexion
claw toe
112
Claw toe: often in all toes except?
big toe
113
_____ ______ = MTP and PIP synovitis, usually involves __ toe, flex of PIP and hyperextension of DIP
hammer toe ; 2nd
114
Hammer toe is similar to what finger deformity ?
boutonniere
115
_____ _____ = flexion of DIP, affects longest toe
mallet toe
116
____ _____ = contracture of instrinic muscles w/ dorsal subluxation of lateral extensor tendons
swan neck
117
Swan neck = ____ of MCP, hyperextension of _____ and flexion of ____
flexion; PIP; DIP
118
Test for swan neck deformity ?
Bunnel Littlers
119
_________ = rupture of central tendinous slip of extensor hood
boutonniere
120
Boutonnières = zig - zag deformity; ______ of MCP, _____ of PIP and _______ of DIP
extension; flexion; hyperextension
121
Test for boutonnières?
central slip tendinitis
122
_______ ______ = most common hand deformity in RA;
ulnar drift
123
ulnar drift = involves synovitis of ____ + structural differences; causes _____ subluxation / laxity of MCP in radial collateral ligaments
MCP; volar
124
Tests for ulnar drift deformity ?
radial collateral ligament test; extensor tendon subluxation test
125
Rx for ulnar drift?
1. lateral finger walking
| 2. joint protection
126
Test for thumb deformities?
grind and crank
127
2 Rx for thumb deformities?
1. web space massage / stretch
| 2. opposition and abduction exercises
128
DRUJ instability: _______ at joint, stretches ulnar carpal ligaments, ulnar head will sublux ______
synovitis; dorsally
129
DRUJ instantly: _____ is displaced and becomes a FLEXOR tendon
ECU
130
Test for DRUJ instability ?
ballottement test
131
________ contracture = contract of the palmar fascia
Dupuytrens
132
Dupuytrens = affects MCP's and PIPs of ___ and ___ digits
4th, 5th
133
____ _____ = thenar muscle wasting w/ first digit moving dorsally until in line w/ second
ape hand
134
Ape hand results from ____ nerve dysfunction
median
135
_____ ______ = rupture of avulsion of extensor tendon at its insertion into distal phalanx
mallet finger
136
Mallet finger causes _______ at DIP
flexion
137
Gamekeeper's thumb = sprain / rupture of _____ of MCP at first digit leading to ______ instability
UCL; MEDIAL
138
______ = genetic disorder of purine metabolism
gout
139
Gout leads to increased serum _____ acid
uric (hyperuricemia)
140
Gout = acid forms ______ and deposits into joints; most affected joints in gout?
crystals; knee and great toe!
141
Rx for gout? (4 meds)
1. NSAIDs
2. Cox2 inhibitors
3. corticosteroids
4. ACTH
142
3 PT goals for pt w/ gout?
1. injury prevention
2. education
3. fast intervention
143
_______ = release of enzymes + abnormal biomechanical forces leading to fibrillation and articular cartilage damage
OA!
144
2 results of fibrillation and articular cartilage damage?
1. cartilage loss
| 2. increased bone turnover (osteophytes)
145
6 risk factors for OA?
1. age
2. F>M
3. obesity
4. physical inactivity
5. injury
6. joint stress
146
Name 5 most common OA sites
1. spine
2. hand
3. knee
4. hip
5. foot
147
Osteophytes in facet joints of L spine = _______
stenosis
148
OA at PIP = ______ node; OA at DIP = _____
Bouchard; Heberden
149
_____ = most common affected joint in OA
Knee
150
3 common findings in pt w/ knee OA ?
1. varus
2. flexion contracture
3. crepitus
151
4 S/S of hip OA?
1. walks w/ trendelenberg
2. groin pain
3. osteophytes
4. flexion deformities
152
Most common area affected by OA in foot ?
1st MT joint
153
OA in foot: osteophytes cause ____ _____ + rigidus, bunions
hallux valgus
154
4 main X ray findings of OA?
1. joint space narrowing
2. osteophytosis
3. subchondral cysts
4. subchondral sclerosis
155
4 questions to ask pts suspected of having OA?
1. pain most days over the last month ?
2. pain over the last year?
3. worse with activity ?
4. received with res?
156
3 tests indicative of knee OA?
1. flexion contracture
2. abnormal gait
3. swipe tests / patellar tap test +ve
157
5 categories of Rx for OA?
1. weight loss
2. exercise
3. protective aids
4. medications
5. electromodalities
158
1 lb weight loss = __ lb decrease in knee joint stress per step; aim is to decrease __% of body weight
4; 10
159
Exercise for pt w/ OA: __ min moderate aerobic training, __ minute bouts
30;10
160
Most common med for pts with OA?
acetominophen
161
______ type FAI = decreased / absent waist of the junction of femoral neck and head
CAM
162
CAM type FAI is common in what population ?
young men
163
____ type FAI = abnormal acetabulum provides excessive cover of femoral head
pincer
164
______ or deep acetabulum seen in pincer type FAI
retroverted
165
Pincer type FAI is common in what population ?
women 30-40 years old
166
Does spondyloarthritis have a rheumatoid factor ?
NO
167
5 characteristics of spondyloarthritis ?
1. spine inflammation
2. synovitis
3. eye inflammation
4. NO RF (seronegative)
5. can be hereditary
168
Gene commonly found in pts with spondyloarthritis?
HLA-B27
169
Is psoriatic arthritis more common in males or females?
equally common!
170
4 characteristics of psoriatic arthritis ?
1. chronic
2. erosive
3. inflammation
4. affects digit joints + axial skeleton
171
2 types of psoriatic arthritis?
1. dactylitis
| 2. enthesitis
172
Common sites of enthesitis in psoriatic arthritis ?
heels and back
173
5 meds for psoriatic arthritis ?
1. acetaminophen
2. NSAIDS
3. DMARDs
4. corticosteroids
5. biological response modifiers
174
3 PT goals for pt w/ psoriatic arthritis ?
1. joint protection strategies
2. maintain joint mechanics
3. endurance
175
_______ spondylitis = related to inflammatory conditions of the bowel
enteropathic
176
2 conditions related to enteropathic spondylitis?
1. ulcerative colitis
| 2. chrons disease
177
Is ulcerative colitis or Chrons disease more severe?
Chrons! (affects whole bowel, whereas ulcerative colitis just affects lower half of bowels)
178
Enteropathic spondylitis can also affect the spine, SI joint and limb joints (T/F)
TRUE
179
______ arthritis is triggered by infection in bowel or GI tract
reactive
180
3 S/S of reactive arthritis ?
1. affects LE
2. hot and swollen joints
3. SYMMETRICAL!
181
AS = onset before ___, males > females
40
182
Low back pain and ______ = hallmark sign of AS
sacroiliitis!
183
AS: increased kyphosis T spine, _____ lumbar lordosis
DECREASED!
184
Dx of AS?
HLA-B27 marker
185
4 meds for AS?
1. NSAIDs
2. corticosteroids
3. cytotoxic
4. tumour necrosis factor (biologics!)
186
3 PT goals for pt w/ AS?
1. trunk flexibility
2 endurance
3. improve resp function
187
AS = stiffness / fusion of spine due to ________, usually bilateral but may initially start as unilateral and migrate
inflammation
188
_______ = inflammation where tendon, legs and joint capsule attach to bone
enthesitis
189
Result of enthesitis = bony _____ and overgrowth
erosion
190
Are pts with AS at increased or decreased # risk?
increased! have OP + fusion / rigidity
191
Enthesitis will affect rib cage = decreased ______ _______
chest expansion
192
_________ = bony spurs on 2 sides of a joint, cause bony fusion and rigidity
syndesphmophytes
193
Synovitis usually affects peripheral joints: name 4
1. shoulders
2. hips
3. knees
4. ankles
194
AS: may cause _______ ______ in lungs, avoid smoking
apical fibrosis
195
AS: can cause ______ / ______ of conduction system, and aortic _______
inflammation; scarring; inflammation
196
AS can also affect eyes and bowel (T/F)
TRUE
197
7 clinical criteria for AS?
1. LBP and stiffness for > 3 months
2. AM stiffness
3. altered posture / muscle imbalances
4. decreased strength / reconditioned
5. decreased L spine ROM in sagittal and frontal planes
6. altered breathing mechanics
7. fatigue
198
AS: LBP is worse with ____, better w/ _____
rest; exercise
199
6 deformities seen in AS?
1. HFP
2. thoracic kyphosis
3. flattening of anterior chest way
4. protrusion of abdomens
5. flattening of lumbar lordosis
6. slight hip flexion
200
AS: will have _______ breathing pattern and ______ vital capacity
diaphragmatic; decreased
201
7 measures to take for AS ROM?
1. posture (tragus to wall)
2. lateral trunk flexion
3. trunk flexion (modified schooners)
4. trunk extension (smythe test)
5. chest expansion
6. trunk rotation
7. cervical mobility
202
4 meds for pts with AS?
1. DMARDs
2. NSAIDs
3. corticosteroids
4. biologics
203
5 categories for physical management of AS?
1. control / decrease inflammation
2. P management
3. decrease stiffness / increase ROM
4. posture correction
5. increase mm strength and endurance
204
2 outcome measures to use for pt w/ AS?
1. BASFI (disease impact on function)
| 2. BADAI (how disease is managed)
205
JIA = life time disease (T/F)
TRUE
206
Ax for JIA?
1. pain
2. ROM
3. joint count
4. muscle strength / length
5. fatigue
6. orthotics
7. gait aids
207
Dx of JIA: S/S must be present for __ weeks; subtype determined by presentation in 1st ___ months
6;6
208
Does JIA affects the eyes?
YES (uveitis)
209
JIA can affect the synovium, tendon sheath synovium and entheses (T/F)
TRUE
210
JIA: Complete remission of disease in __% of kids if occurs before age __
75;16
211
RA most typically affects what 2 joints?
1. MCP
| 2. PIP
212
CI's / red flags for exercise in RA and OA? (6)
1. increase in pain, fatigue, or AM stiffness
2. sudden pain at joint or joint deformity
3. joint becomes red, swollen and hot after doing exercise (within 24 hours)
4. decrease in muscle strength and function (local myositis)
5. neurological SSx
6. SOB on mild exertion
213
Precautions for exercise in RA/OA?
1. watch our for inappropriate exercise that can harm joints
2. swollen joints at risk for capsular stretch and rupture
3. OP bone at risk for #
4. use machine and resistance bands rather than free weights
214
_____ ______ questionnaire = measures difficulty performing ADLs on past week; good measure of disease activityl most widely used functional measure in rheumatology
health assessment (HAQ)
215
Do you want a lower or higher score in the HAQ?
Lower!
216
________ - __ = measures QOL profile, looks at self care, ADL, pain / discomfort, anxiety and depression, used in general population along w/ RA and OA
EuroQol - 5D
217
_________ = assess disability in RA patients (specific pt picked activities that are affected by RA); 5 activities, questionnaire administered by PT
MACTAR
218
MACTAR = better for ____ term follow up rather than _____ term
short; long
219
MACTAR: is a lower or higher score better?
higher; ranges from -1 --> +1, +1 is better
220
______ _____ _____ test = lower body strength in older adults as an indicator of functional status; some predictive validity for falls
timed chair chair test
221
Timed chair stand test = time for 1, 5, or 10 reps; or reps in a ___ s period
30
222
_____ or _____ = short and long term pt relevant outcome measure of knee or hip injury that can result from traumatic OA; 5 dimensions (pain, other symptoms, ADLs, sport and recreation fxn, knee or hip related QOL)
knee / hip injury and OA outcome measures (KOOS or HOOS)
223
____ or _____ = for people w/ ACL injury, meniscus injury, post traumatic OA, hip or knee pathologies post surgical, etc
KOOS; HOOS
224
Type __ DM = beta cell destruction usually leading to absolute insulin deficiency
1
225
Type __ DM = variation from insulin resistance and increased insulin levels to a dominant defect in insulin secretion w/ insulin resistance
2
226
There are > 40 well defined types of diabetes (T/F)
TRUE
227
______ regulates glucose levels, promotes glucose uptake into the cells for storage
insulin
228
How is glucose stores in the liver, muscle and adipose tissue ?
as glycogen
229
Type 1 DM = _____ onset, requires insulin, immune mediated attach of _____ cell in pancreases
juvenile; islet
230
There is a ____ in circulating insulin in type I DM
DECREASE
231
Presentation of type __ DM = weight loss, increased urination and dehydration
1
232
Type 2 DM = ___ onset, dont need insulin bc they don't respond to it, causes insulin resistance in _____ tissues
adult; peripheral
233
Presentation of type ___ DM = obese, acanthosis nigricans (hyperpigmented skin in axilla, groin, back of neck) and HTN
2
234
_______ = dizzy, weak, nauseous, sweating profusely; fatigue; irritably, confusion, fainting
hypoglycaemia
235
What S/S of hypoglycaemia rules out orthostatic hypertension?
sweating profusely!
236
_______ = blurred vision, fatigue, thirst, frequent urination, weakness, abnormal breathing; acetone breath
hyperglycaemia
237
3 long term effects of hyperglycaemia?
1. damage to small blood vessels (retinopathy and diabetic nephropathy)
2. damage to large blood vessels
3. damage to peripheral nerves (diabetic neuropathy)
238
Normal glucose levels fasting? Diabetic fasting levels
| ?
5.6 mmol/L; > 7 mmol/L
239
Impaired fasting plasma glucose < ___ mmol/L to > __ mmol/L
5.6;7
240
5 long term consequences of diabetes?
1. peripheral (diabetic neuropathy, ulcers, amputation)
2. kidney failure
3. diabetic retinopathy
4. heart disease
5. infection
241
6 things to keep in mind when exercising w/ pts with DM?
1. regular exercise = very important
2. talk to MD re insulin levels for exercise
3. have snack before
4. monitor blood sugar levels pre, during and post exercise
5. avoid exercise at night!!!
6. PT to ALWAYS monitor pt for s/s of hyper or hypoglycaemia
242
SCI: ____ of pts w/ SCI develop chronic pain
2/3
243
Pain is transmitted via what 2 types of fibers ?
1. A delta
| 2. C fingers
244
___ _____ fibers = high threshold, sharp prickling, localizing, fast adapting
A delta
245
____ fibers = low threshold, dull, aching, diffuse, slow adapting and persistent
C
246
Do meds work well for A delta or C fibres ?
A delta!! Do not work well for C!
247
Conduction of pain = at SC goes up ____ _____ tract to thalamus and to the cortex
lateral spinothalamic
248
_______ ______ = released endorphins and inhibits substrate P and glutamate release, therefore decreasing pain
periacqueductal grey
249
Chronic pain = actual chemical changes occur in tissue and brain, receptors become hypersensitive leading to ______ or _____
allodynia; hyperalgesia
250
3 Rx for chronic pain ?
1. desensitize area
2. educate them that it is not in their head
3. restore normal function to area
251
______ ______ _______ = by exclusion, persistent of relapsing fatigue for at least 6 months NOT reduced w/ bed rest, reduces daily activity by at least 50%
chronic fatigue syndrome
252
PT role in chronic fatigue syndrome?
checking exercise tolerance
253
________ = chronic pain syndrome affecting mm and soft tissue
fibromyalgia
254
7 S/S of fibromyalgia ?
1. headaches
2. sensitivity to stimuli
3. fatigue
4. myalgia
5. sleep disturbances
6. generalized aching
7. anxiety / depression
255
Fibromyalgia = will have + at ___/ 18 points ; name these points.
11;
1. occiput
2. lower cervical (C5-7)
3. traps (mid point of upper border)
4. supraspinatus (origin)
5. second rib
6. lateral epicondyle
7. gluteal
8. greater trochanter
9. knee
256
2 PT Rx for fibromyalgia ?
1. energy conservation
| 2. aquatic therapy
257
______ = presence of whole body inflammatory state (SIRS) + presence of unknown infection
sepsis
258
Septic shock = severe sepsis but _______ abnormalities in spite of adequate fluid resuscitation
hypo perfusion
259
Septic shock = ______ system spirals out of control, normal response to infection is local but then causes widespread _______ and vascular _______
immune; vasodilation; permeability
260
_______ = poor distribution of blood at the microcirculation level
shock
261
shock = decreased tissue ______, does not meet cellular needs leading to cell death
perfusion
262
4 types of shock ?
1. hypovolemic
2. cardiogenic
3. distributive
4. obstructive
263
_______ shock = blood loss
hypovolemic
264
______ shock = due to heart damage
cardiogenic
265
_______ shock = hypotension and general tissue hypoxia
distributive
266
_______ shock = great vessels of heart, usually goes with cardiogenic shock
obstructive
267
________ = whole body inflammatory state, dx w/ body temp, HR, RR and WBC count
SIRS
268
SIRS = dx along w/ 2 or more of the following signs: HR > ___, temp > ___ or < ___, RR > ___ OR PaCO2 < __, WBC count > _____ and < _____
90; 38; 36; 20; 32; 12000; 4000
269
BMI equation?
weight (kg) / height (m) ^2
270
Overweight BMI = b/w ___ - ___
25-29.9
271
Obesity= BMI > or = ___
30
272
Morbidly obese = > or = __
40
273
Skin caliper test: fat greater than __ inch is in excess
1
274
______ obesity is an independent predictor of morbidity and mortality
abdominal
275
FITT parameters for pts w/ obesity ?
F: 5-7 days a week
I: mod intensity (40-60% progress to 50-70% HRR)
T: 45 - 60 mins
T: circuits or aquatics
276
Pts w/ obesity: be mindful of response to heat, excess fat leads to heat _____ and can lead to _______
insulation; overheating
277
Normal weight gain in pregnancy = __ - __ lbs
20-30
278
Preterm = < ___ weeks
37
279
5 postural changes w/ pregnancy ?
1. inc thoracic kyphosis
2. forward lean in C spine
3. inc lumbar lordosis
4. inc breast size
5. shoulder protraction
280
Pregnancy = decrease in ____ and ____ closure, and pelvic floor is on stretch
form; force
281
Pregnancy: incontinence in __% of vaginal deliveries
67
282
4 PT antepartum concerns ?
1. antepartum bleed
2. preterm labor (irritable uterus w/ mini contractions)
3. ruptured membrane (slow trick of fluid, not water breaking)
4. incompetence cervix / changes
283
_______ ______ ______ = lateral separation / split of rectus abdominus; separation from midline > ___ cm significant, may be deterred in 2nd trimester
diastasis recti abdominus; 2.5
284
3 effects of diastasis rectus abdominis?
1. weak abdominal wall
2. dec support for back and viscera
3. related to lumbo pelvic pain
285
5 Rx for diastasis rectus abdominis?
1. education
2. posture and body mechanics
3. movement patterns and recruitment strategies
4. exercises
5. abdominal binders
286
Recovery for diastasis rectus abdominis = usually __ - __ months
2-6
287
CTS / De quervains = usually seen in ___ trimester, d/t increase in ____ and pressure, ______ changes, poor lifting/carrying technique of cobbler or newborn
2nd; pressure; hormone
288
4 Rx for CTS/ de quervains due to pregnancy ?
1. education
2. ice
3. electrotherapy
4. stretching
289
______ _______ = S/S include heaviness, dull pain /ache in legs w/ standing and walking, may be incapacitating pain
varicose veins
290
5 Rx for varicose veins ?
1. posture
2. positioning elevation
3. limit cross legged time
4. pressure graded stockings / tights / underwear
5. circulatory exercises
291
3 types of incontinence ?
1. stress
2. urge
3. mixed
292
Incontinence: ______ abdominal recruitment w/ ____ intra-abdominal pressure, or strong need to urinate when on way to toilet
decreased; increased
293
6 causes of incontinence?
1. injury to connective tissue
2. damage to pelvic nerves and muscles
3. direct injury to urinary tract
4. changes in pelvic floor anatomy
5. urethral weakness
6. vaginal relaxation
294
5 Rx for incontinence ?
1. PF exercises
2. co contraction of TA and PF
3. posture and body mechanics
4. urgency techniques
5. diet changes
295
PF exercise: ___ s holds, __ contractions, __ - __ x a week
10;10; 2-3
296
______ diabetes = abnormal blood sugar reading 1st seen during pregnancy; undetected or mismanaged can lead to very high risk to baby and mom!
gestational
297
Rx for gestational diabetes may include?
1. team
2. insulin
3. diet
4. exercise *(20 minute walk post meal)
298
Overall Rx for pregnancy: what are 6 things to avoid?
1. valsalva, exercise techniques that stress PF and abdominals
2. rapid uncontrolled movements
3. positions of inversion
4. deep heat modalities or EStim
5. manual therapy
6. positioning (prone not well tolerated, supine ok for short periods)
299
3 red flags for reproductive problems ?
1. change in B/B and sexual function
2. non mechanical LBP
3. suprapubic of groin pain
300
3 pelvic floor disorders?
1. cystocele
2. rectocele
3. uterine prolapse
301
6 S/S of pelvic floor disorders ?
1. increase in symptoms w/ activity / at end of day
2. pelvic pain
3. urinary incontinence
4. pain w/ sexual intercourse
5. heaviness in saddle region
6. incomplete B/B emptying
302
Rx for pelvic floor disorders if not resolved after ___ weeks may include what 4 things ?
6;
1. pelvic floor mm exercise
2. postural re education
3. pessary
4. Sx
303
_______ = pregnancy induced acute HTN after 24 weeks gestation
pre eclampsia
304
5 S/S of pre eclampsia?
1. HTN
2. edema
3. headache
4. visual disturbance
5. hyperreflexia
305
Is it safe to use TENS around incision for C section?
YES
306
___ degree burn =superficial, erythema appearance
1st
307
__ degree burn = partial thickness, blistering appearance
2nd
308
__ degree burn = full thickness, necrosis
3rd
309
Rule of __ = to determine body surface area involvement. Name the 5 body parts and their SA
9's
1. head = 9
2. torso = 36
3. each arm = 9
4. each leg = 18
5. pubic area = 1
310
2 differences for rule of 9's in kids?
1. head = 18
| 2. each leg = 14
311
Scarring = only occurs if there is significant damage to the ______
dermis
312
3 phases of wound healing ?
1. inflammatory
2. proliferative
3. remodelling
313
______ phase = vascular and cellular effects to eliminate the necrotic tissue and deliver materials for healing
inflammatory
314
_______ phase = rebuild the dermis and epidermis, fibroplasias and neovascularization that produce granulation tissue (early angiogenesis)
proliferative
315
______ phase = wound contract and increases strength, scar
remodelling
316
3 classifications for wound healing?
1. acute vs chronic
2. partial vs full thickness
3. primary vs secondary
317
3 different zones in a wound ?
1. zone of coagulation
2. zone of stasis
3. zone of hyperemia
318
Zone of _______ = point of maximum damage, irreversible tissue loss
coagulation
319
Zone of _____ = decreased tissue perfusion, potentially salvageable
stasis
320
Zone of _______ = increased perfusion, will recover unless sepsis occurs
hyperaemia
321
5 effects of burns on the CV system?
1. inc capillary permeability (interstitial edema)
2. peripheral vasoconstriction
3. hypovolemia
4. myocardial depression (hypotension and decreased organ perfusion)
5. decreased cardiac output
322
Metabolism can increase up to 3x due to a burn (T/F)
TRUE
323
Immune system is compromised due to a burn (T/F)
TRUE
324
Burns can lead to bronchoconstriction, ARDS and if there is carbon monoxide exposure it can increase O2 carrying capacity of blood (T/F)
FALSE ; CO DECREASES O2 carrying capacity of blood
325
Effects of burns on renal system: due to loss of fluids, = vasoconstriction, ___ in GFR. ____ in myoglobin, gets processed in kidneys and can block tubules
decrease; increase
326
6 signs of an inhalation injury?
1. singed eyebrows / nasal hairs / burnt face
2. black oral / nasal discharge
3. swollen lips
4. hoarse voice
5. abnormal oxygenation
6. history of being enclosed in a room
327
Inhalation injury process: w/in ___ hours upper airway obstruction / pulmonary edema
24
328
Management of inhalation injury may include what 3 things?
1. early mobilization
2. breathing exercises
3. postural drainage
329
PT Rx for burn wounds: first 2-3 weeks may include what 4 things?
1. AROM and PROM to maintain range
2. positioning
3. edema management
4. encourage ambulation
330
Scar management is a huge part of PT Rx for burns bc pt can get a scar tissue contracture within __ - ___ days
1-4!
331
4 CI's to exercise w/ burn pts?
1. exposed joint
2. fresh skin graft
3. DVT
4. compartment syndrome
332
____ thickness skin graft uses skin graft, stitched, glued or sutured in place
split
333
____ thickness skin graft = skin transplant
full
334
Split thickness skin graft = immobilize for __ days
5
335
4 Rx for skin grafts?
1. scar massage
2. sun protection
3. ROM
4. pressure garments
336
Post skin graft strengthening can begin in __ - __ weeks
3-4
337
Scar from burns: __ - __ weeks = fibroblastic / proliferative
0-4
338
Scar from burns: __- __ weeks = early remodelling
4-12
339
Scar from burns: __ - __ = late remodelling / maturation
12-40
340
4 factors that can influence a scar?
1. age
2. smoking
3. type of tissue
4. nutrition
341
5 modifiable risk factors for wounds / ulcers?
Any of ...
1. autonomic dysreflexia
2. incontinence
3. smoking
4. obesity
5. poor nutrition
6. comorbidities
7. depression
342
5 non modifiable risk factors for wounds / ulcers?
Any of ...
1. dec sensation
2. activity and mobility
3. mm atrophy
4. completeness of injury
5. age
6. hx of previous wounds
7. inc tissue temp, moisture
8. spasticity
343
Name 4 areas at risk for wounds in lying
1. occiput
2. elbow
3. sacrum/coccyx
4. heels
344
Name 5 areas at risk for wounds in sitting
1. shoulder blade
2. sacrum / coccyx
3. ischial tub
4. post knee
5. foot
345
4 causes of ulcers?
1. pressure
2. shearing
3. friction
4. deep tissue damage from banging or bumping
346
Ulcers caused by _____: blisters can be a sign, and spasticity is a common cause
friction
347
Stage __ wound: reddened (non blanch able)
1
348
Stage __ wound = skin is broke, small crater
2
349
Stage __ wound = deep crater might be infected, may be back, dead tissue
3
350
Stage __ wound: deep through muscle to the bone or joint
4
351
7 ways to describe a wound?
1. location
2. size
3. wound base
4. wound edges
5. surrounding skin
6. stage
7. photos
352
Wounds: red area should disappear after __ - __ minutes
20-30
353
2 points to touch on for client education re wound prevention?
1. look at skin 2x a day, check all bony prominences, use a mirror and attendants
2. look for change in colour, temp, texture, persistent erythema, discolouration
354
Use the _____ scale for Ax of risk of wound
Braden
355
Very high evidence for use of _____ for wound healing
HVPC!!!
356
_________ = autoimmune disease that affects the skin; faulty signs that speed uptake growth cycle of skin cells
psoriasis
357
______ leads to profound cutaneous inflammation and epidermal hyper proliferation
psoriasis
358
5 cardinal signs of psoriasis?
1. plaque
2. well circumscribed margins
3. bright salmon red colour
4. silvery micaceous scale
5. symmetrical distribution
359
1 way to differentiate psoriasis from eczema ?
psoriasis is more likely to be found on the OUTER side of the joint
360
Severe psoriasis is associated with risk of CV disease and death (T/F)
TRUE
361
5 Rx for psoriasis?
1. topical creams containing glucocorticoids
2. tars
3. vit D or A
4. phototherapy w/ UV light
5. systemic therapy w/ immunosuppressive drugs
362
______ = form of dermatitis or inflammation of the epidermis; itchy, red, scaly disorder
eczema
363
2 types of eczema ?
1. atopic dermatitis
| 2. contact dermatitis
364
________ dermatitis = intensely itchy skin disorder associated w/ atopy, predisposition towards developing allergic hypersensitivity reactions (asthma, hay fever, and allergic conjunctivitis)
atopic
365
Atopic dermatitis is also known as _______ eczema
endogenous
366
Presentation of atopic dermatitis (4 points):
1. itchiness***
2. lichenification (thickening of skin lines)
3. excoriations (scratching or picking at skin)
4. crusting
367
3 phases of atopic dermatitis and main points?
1. infantile (facial and extensor distribution)
2. childhood (dry skin, flexural distribution esp popliteal and cuboid fossa)
3. adult (generally improves w/ age, primarily affects the hands)
368
5 Rx for atopic dermatitis?
1. avoid irritating factors
2. moisturizers
3. topical glucocorticoids
4. oral antihistamines
5. UV therapy
369
Contact dermatitis = also known as _______ eczema
exogenous
370
______ contact dermatitis = immune hypersensitivity to an allergen in contact w/ the skin
allergic
371
______ contact dermatitis = contact of skin w/ something that primarily causes direct local irritation
irrtant
372
Rx for contact dermatitis?
usually topical steroids, clears up in 7 - 10 days
373
Seborrheic dermatitis = occurs in areas of high _______ gland activity, probably due to an excessive immune response to a _____
sebaceous; yeast
374
3 associated disorders w/ seborrheic dermatitis ?
1. PD
2. neurological Dx
3. HIV pts
... aka things that dec mobility
375
Rx for seborrheic dermatitis?
antifungals
376
3 main function of the livers?
1. producing ALBUMIN
2. producing CLOTTING factors
3. ammonia metabolism
377
Albumin has a large role in ______ transmission
fluid
378
5 S/S of hepatitis ?
1. yellow
2. itching
3. big belly (ascites)
4. bleeding
5. esophageal varices
379
Hep ___ = virus transmitted by fecal oral route, usually self limited bout; risk facts = international travel and daycare
A
380
7 S/S of Hep A ?
1. jaundice
2. fatigue
3. weakness
4. anorexia
5. nausea
6. vomiting
7. abdominal pain
381
Children w/ Hep A are often symptomatic (T/F)
FASLE ; usually asymptomatic
382
Hep __ = infection of liver, can persist and become chronic, long standing can lead to cirrhosis and hepatocellular carcinoma
B
383
Example of high risk spread of Hep B?
mother to child
384
Example of low risk spread of Hep B?
sexual transmutation and injection drug use
385
Is there a cure for Hep B?
NO
386
3 ways to transmit Hep C?
1. percutaneous (needle stick)
2. non percutaneous (sexual)
3. hemodialysis
387
Hep C has a ______ risk of turning chronic from acute compared to Hep B , can take decades for chronic complications to occur
HIGHER
388
2 Rx fo Hep C?
1. interferon
| 2. antiviral agents
389
_____ disease = hyperthyroidism, autoantibodies stimulate the thyroid (TSH receptor)
Graves
390
T3 and T4 _____ the secretion of TSH
inhibit!
391
Will T3 and T4 be high or low in Grave's disease?
HIGH
392
7 S/S of Graves disease?
1. fever
2. weight loss
3. exercise intolerance
4. goiter
5. bulging eyes
6. tachycardia
7. decreased fertility
393
Bulging eyes seen in Graves disease = _______
exophthalmos
394
4 Rx for Graves disease?
1. beta blockers for HR
2. anti-thyroid drug therapy
3. radioactive iodine
4. surgical removal of thyroid
395
_________ thyroiditis = hypothryrodism; autoimmune destruction of the thyroid gland
hashimoto
396
In Hashimotos, T3 and T4 are ___ and TSH is ___
LOW; HIGH
397
6 S/S of hashimotos
1. weight gain
2. cold intolerance
3. round puffy face
4. bradycardia
5. constipation
6. depression
398
Rx for hashimotos?
thyroid hormon replacement
399
_________ disease = autoimmune process against the adrenal cortex, FATAL if not treated, great prognosis if treated
Addison's
400
6 S/S of Addison's disease?
1. weakness
2. fatigue
3. anorexia
4. hyponatremia
5. hypoglycaemia
6. hyperpigmentation
401
Rx for Addisons disease = replace missing adrenal hormone with _____ and _____
aldosterone; cortisol
402
______ disease = chronic glucocorticoid (cortisol) excess; can get from cancer of the adrenal gland
Cushing's
403
3 S/S of Cushing's disease ?
1. moon face
2. central obesity
3. abdominal striations
404
_______ disease: affects the entire GI tract from mouth to anus, small and large intestines
Chrons
405
Chron's disease: can have skipped lesions (normal segments) T/F
TRUE
406
Chron's disease: ulcers, fissue and fistulas, get alterations in digestion and absorption = ________
malnutrition
407
4 Rx for Chron's disease?
1. anti-inflammatory drugs for bowl
2. prednisone
3. anti-biotics
4. biologic therapies
408
_____ ______ = same as Chron's but no skipped lesions
Ulcerative colitis
409
Ulcerative colitis only affects the _____
Colon
410
Ulcerative colitis: can have significant ______ and ______
bleeding; anemia
411
______ tumor = carcinoma
epithelial
412
_______ tumor = sacroma
mesenchymal
413
_______ tumor = glioma
glial
414
_______ tumour = lymphoma
lymphoid
415
_______ tumor = leukemia
hematopoietic
416
________ tumor = melanoma
melanocytic
417
TMN staging for tumors?
1. tumour (extent / spread)
2. nodes
3. met (distant / local)
418
6 aspects of the clinical presentation of cancer survivors?
1. fatigue
2. myalgia
3. arthralgia
4. bone health
5. peripheral neuropathy
6. deconditioned
419
____ ____ lung cancer = 20-25% develop into bronchial cell mucosa, spread rapid and met early
small cell
420
_____ lung cancer (non small cell) = slow speed, arises in central portion near hilum, mets late
squamous
421
_________ lung cancer (non small cell) = 30-40% slow to mod spread, early mets through lungs. brains and other organs
adenocarcinoma
422
____ ____ lung cancer = rapid spread, wide spread mets, kidney, liver adrenals and other organs so poor prognosis
large cell
423
Brain tumor = __ cause of death in brain, __ % survival rate
2nd; 50
424
_______ _______ brain tumor = from lung, breast, prostate, compensate by decreasing brain tissue, CSF and blood flow volume
Intracerebral metastatic
425
_____ ______ brain tumor = nerve root pain, worst at night, cough , radicular pain, Rx = surgery or radiation
intra spinal
426
_____ _____ ________ brain tumor = benign, good survival if treated early
low grade astrocytoma
427
________ brain tumor = frequent mets to other areas of brain / spine
medulloblastoma
428
________ brain tumor = schwannoma; CN 8; headaches, seizure, nausea, vomiting, cognition and behaviour changes
neuromas
429
_________ tumor = end of long bones, produces pain, Xray will show moth eaten appearance, usually secondary primary is rare (may occur in youth), treatment = Sx
osteosarcoma
430
______ ______ tumor = usually in larger joints, = swelling and instability, treatment = surgery +/- radiation and chemo
synovial sarcoma
431
_______ ______ tumor = benign tumor, exercise related bone pain and tenderness, abolition of symptoms w/ ASPIRIN, Tx = ablation, ethanol or laser
osteoid osteoma
432
________ cancer = in men > 50, treatment = Sx, external beam radiation, brachytherapy, androgen deprivation therapy
prostate
433
____ ______ carcinoma = most common form of skin cancer, low risk of spreading, translucent and red in colour
basal cell
434
_____ _____ carcinoma = solid skin tumour, often volcano shaped, HIGH risk for mets
squamous cell
435
_________ ______ = most dangerous, HIGH potential for mets
malignant melanoma
436
ABCD rule for melanoma?
```
A = asymmetry
B = border
C = colour
D = diameter
```
