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multisystems Flashcards

1
Q

rheumatoid arthritis definition

A

systemic inflammatory autoimmune disease - symmetrical polyarthrtitis
30-45 age onset F>M
rhematoid positive factors in 70% (more severe cases)
ESR and CRP (creatine-reactive proteins) positive during active RA
synovial fluid - cloudy, will clot, less viscous during active inflammation

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2
Q

RA pathophys

A

inflammation of synovium leads to effusion, pain, stiffness and limited ROM in the joint
chronic inflammation - immune cells break down articular cartilage
synovial overgrowth of granulation tissue (pannus) dissolves articulum
joint space narrows causing psuedo-laxity
tendon sheaths fray, tendons rupture leading to muscle imbalances
granulation tissue results in adhesions, fibrosis or fusion of the joint

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3
Q

x-ray findings RA

A

joint space narrowing unevenly (cartilage erosion) - secondary OA
bone erosion and peri-articular osteopenia
rheumatoid nodules and swelling

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4
Q

ARC 1987 criteria for classification of RA

A

need at least 4 of 7 criteria**
criteria 1 to 4 must have been present for 6 weeks**

  1. morning stiffness =/> 1hr
  2. soft-tissue swelling/fluid in at least 3 joints simultaneously
  3. at least 1 area swollen in wrist, MCP or PIP
  4. symmetrical arthritis
  5. rheumatoid nodules
  6. abnormal amounts of serum rheumatoid factor
  7. erosions or bony decalcification on x-ray wrist and hand
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5
Q

signs/symptoms RA

A

morning stiffness > 1 hr
generalized stiffness that eases with movement
extreme fatigue (increased resting energy expenditure)
rheumatoid cachexia - loss of lean body mass, muscle wasting
signs of systemic disease - loss of apetite/weight loss, fever, malaise
crepitus
deformity
joint pain
swelling

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6
Q

RA red flags (urgent referrals)

A

claudication pain pattern
systemic disease signs (fever, weight loss, malaise)
focal or diffuse weakness
history of significant trauma
hot, swollen joint
neurogenic pain (burning, numbness, paresthesia)

*Cord compression signs - neurological signs and cervical radiculopathy (spinal cord compression may come from inflammation in the cervical spine.) URGENT ER

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7
Q

Standardized assessment of joint inflammation (SAJI)

A

active joint (1 of the following must be present)
STOP - swelling, tenderness, over pressure
1. effusion - 2 thumb technique, 4 finger technique, palpation
2. joint line tenderness
3. stress pain - pain with passive overpressure

damaged joint (1 of the following must be present)
1. subluxation or deformity
2. bone on bone crepitus
3. loss of more than 20% of PROM
4. ligament instability

raynauds disease - triggered cold/stress vasomotor constriction of arteries
nerve compression

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8
Q

contraindications for RA (ACTIVE)

A

superficial heat - not on inflammed, hot, swollen joints (hot packs, LLLT, paraffin wax, hypdrotherapy)
deep heat - during acute inflammatory stage (ultrasound)
cold - in patients with raynauds disease
stretching
strengthening

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9
Q

lupus definition

A

autoimmune disorder causing production of antibodies

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10
Q

lupus signs/symptoms

A

systemic disease signs - fever, malaise, fatigue
skin abnormalities - malar rash (butterfly), discoid rash, photosensitivity
alopecia
oral or nasopharyngeal ulcers
pleuritic chest pain and SOB
pericarditis, hypertension, raynauds
headaches, seizures, psychosis
nonerosive arthritis - symmetrical in PERIPHERAL joints - (not hip or spine)
ANA positive - anti-nuclear bodies *hallmark lab values

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11
Q

SLE/lupus PT management

A

energy conservation techniques
avoid sun exposure UV light
breathing exercises
modalities for pain/effusion
ROM exercises
NO STRETCHING*
NO STRENGTHENING during acute flare ups

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12
Q

AS Ankylosing Spondylitis definition

A

seronegative spondyarthropathy chronic inflammatory of the axial spine
M>F age 15-30
HLA-B27 gene
c-reactive protein and ESR increased during active inflammation
insidious onset progressing from caudal to cephalad

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13
Q

AS signs/symptoms

A

insidious onset progressing from caudal to cephalad
morning stiffness 30-40 mins
nocturnal pain
low back, SIJ, glute pain and stiffness
loss of ROM spine, hips, shoulders
postural abnormalities
tenderness over enthesitis sites - insertion of muscle (plantar fascia, achilles, ischial tuberosity
systemic signs - fatigue, eye anterior uveitis

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14
Q

AS postural changes

A

increased kyphosis, reduced lumbar lordosis/cervical lordosis, eye upward gaze, fixed thoracic ribcage (restrictive disease), hip and knee flexion

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15
Q

AS x-ray findings

A

sacroiliitis
syndesmophytes - bone growth inside ligaments “bamboo spine”
increased kyphosis
enthesitis - ITB insertion, plantar fascia insertion
arthritis - hip

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16
Q

AS contraindications

A

flexion based exercises
thermotherapy on active inflamed joints

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17
Q

Osteoporosis

A

metabolic bone disease causing reduced bone density & deterioration
typically post-menopausal women

primary osteoporosis - due to post menopause/senile age (70+)
secondary osteoporosis - due to another primary condition (hyperthyroidism) or treatment of another condition (corticosteroids)

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18
Q

Dexa T-score standard deviations

A

> -1 = normal
-1 to -2.5 = osteopenia
-2.5 = osteoporosis
-2.5 & history of at least 1 osteoporotic # = severe osteoporosis

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19
Q

Osteoporosis PT interventions

A

postural education - AVOID FLEXION (ant. wedge # common)
WB exercises - walking, squatting, jogging

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20
Q

osteomalacia (all)

A

metabolic bone disease resulting in softening of bones/decalcification

caused by: inadequate intestinal calcium absorption, increased renal excretion of phosphorus or vitamin D deficiency

signs/symptoms: pain, aching, fatigue, weight loss, weakness, increased thoracic kyphosis, LE bowing, high risk #’s

interventions: meds/nutrition, strength training, bone protection strategy

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21
Q

pagets disease (all)

A

metabolic bone disease with abnormal osteoblast/clast activity followed by disorganized remodeling
M>F, > 40 years old

signs/symptoms: pain, misshapen bones, #’s, arthritis

interventions: meds for pain/ regulating osteoclast activity
postural re-ed, strengthening, stretching, aerobic activity – low impact ex’s (caution with running hard, twisting, jogging)

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22
Q

osteomyelitis (all)

A

inflammation within bone caused by infection
most cases due to bacterial infection, infection through blood stream, open fracture or surgery

signs/symptoms: fever, tenderness/redness/warmth/swelling near site, loss of ROM in affected joints

interventions: antibiotics, surgery, ROM ex’s

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23
Q

skin function layers dermis vs. epidermis

A

protects against infections, UV rays and fluid loss
temp regulation
sensation
secretion of oils for lubrication
vitamin D synthesis + cosmetics

epidermis: most superficial, avascular, free nerve endings, 5 layers
dermis: deepest layer, contains blood vessels, lymphatics, nerve endings, collagen and elastin fibers and wound healing properties

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24
Q

burns classification 1st degree superficial

A

characteristics:
pink/red erythema, no blistering
dry
minimal edema
skin barrier to infection intact
mild pain&raquo_space; SUNBURN

depth: damage to epidermis only

rate of healing: 2-3 days, no scarring

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25
burns classification 2nd degree superficial partial thickness
characteristics: bright pink or red (mottled) intact blister dry surface moist weeping when blister removed moderate edema quick capillary refill very painful - nerve endings damaged sensitive to changes in temp, air exposure, light touch >> SCALD BURN depth: damage to epidermis and into papillary dermis rate of healing: 7-10 days, minimal scarring
26
burns classification 2nd degree deep partial thickness
characteristics: red or waxy white blisters broken wet surface marked edema sluggish cap. refill sensitive to pressure insensitive to light touch/pinprick - nerve endings destroyed >> IMMERSION SCALD, FLAME BURN, COOKING OIL BURN depth: damage to epidermis and into reticular dermis rate of healing: 3-5 weeks, keloid/heterotrophic scar formation (may require grafting)
27
burns classification 3rd degree full thickness
characteristics: white, charred, black or red eschar formation "parchment-like" leathery no blanching with pressure marked edema painless severe infection risk >> FLAME BURN, CHEMICAL BURN depth: damage to epidermis, dermis and partial into subcutaneous tissue rate of healing: 3-5 weeks, keloid/heterotrophic scar formation (may require grafting)
28
burns classification 4th degree subdermal
characteristics: charred skin subcutaneous tissue visible muscle damage neurological involvement large exit wound and small entry wound always severe no matter size of area >> HIGH VOLTAGE ELETRICAL BURN depth: epidermis, dermis, into subcutaneous tissue, bone, muscle, and large nerves rate of healing: extensive, requires surgery, debridement, grafting, amputation
29
signs of inhalation injury
facial burns, singed eyebrows and nasal hairs, harsh cough, hoarse voice, carbonaceous sputum, abnormal breath sounds (wheezing/stridor), respiratory distress, hypoxemia complications: CO2 poisoning, tracheal damage, upper airway obstruction, pulmonary edema, pneumonia
30
heterotrophic scar
excessive scar formation that raises above level of adjacent skin 3 R's (raised, red, and rigid)
31
keloid scar
heterotrophic scar that extends beyond the boundary of original wound
32
burns PT interventions
positioning - elongated position or functional, minimize edema, prevent contractures, preserve function (airplane splint, hamburger hands) splinting AROM - start on admission for all joints even affected, coordinate with pain meds, stop 3-5 days after graft for joints above/below PROM - if pt not alert or unable to follow commands, on children, if unable to achieve AROM, stress is gentle gradual and sustained resistance ex's - beware abnormal thermoregulation, monitor vitals conditioning ex's - monitor vitals, walking, cycling, rowing, stair climbing ambulation - begin as early as possible, stop after LE grafting, TED stockings, elastic wraps to minimize edema in standing pressure dressings and massage for scar management - once wound has healed, pressure 25mmHg worn 23 hours/day** 12-18 months, washed daily
33
diabetes mellitus
metabolic disorders characterized by hyperglycemia due to defective insulin action or secretion beta cells in pancreas produces insulin insulin regulates blood glucose levels by promoting glucose uptake by the liver, adipose cells, and skeletal muscle cells for storage as glycogen
33
diabetes mellitus
metabolic disorders characterized by hyperglycemia due to defective insulin action or secretion beta cells in pancreas produces insulin insulin regulates blood glucose levels by promoting glucose uptake by the liver, adipose cells, and skeletal muscle cells for storage as glycogen
34
type 1 DM
pancreas fails to produce sufficient or any insulin "insulin-dependent or juvenile diabetes" typical onset childhood auto-immune abnormality that damages islet cells of the pancreas
35
type 2 DM
pancreas fails to produce sufficient insulin, as well as resistance to insulin "adult-onset diabetes" causes: OBESITY - BMI > 30, poor diet, abdominal fat, sedentary lifestyle
36
hyperglycemia
blood glucose > 11mmol/L increased thirst frequent hunger increased urination delayed healing ketoacidosis - fruity breath smell > life threatening don't exercise > 16mmol/L GIVE insulin
37
hypoglycemia
drop in blood glucose <3.9mmol/L, high insulin levels increase glucose uptake and drop BP increased physical activity, not eating on time, meds that increase insulin sweating nausea tremors warmth anxiety palpitations hunger headaches confusion weakness seizures coma insulin injections should be taken > 1 hour before exercise check blood glucose before/after exercise avoid exercise at night*, preferably after meal 15:15 rule: if +/< 5.5mmol/L ingest 15-30g carbs - ** wait 15 mins retest
38
peripheral neuropathy DM
insidious onset, affects sensory and motor neurons "glove and stocking" distribution numbness, tingling, burning charcot foot - weakened bones may #, reduced sensation = foot deformity
39
autonomic neuropathy DM
impaired function of peripheral nerves in ANS blunted HR and BP response to activity high resting HR impaired peripheral vasodilation, impaired sweating, poor thermoregulation increased risk post-exercise hypotension/orthostatic hypotension
40
diabetic retinopathy
avoid activities that cause sudden increase in BP valsalva maneuver, heavy lifting, strenuous UE ex's, head down postures
41
effects of exercise on DM
increased insulin sensitivity reduced insulin resistance increased insulin uptake improved blood glucose control reduced risk diabetic complications
42
exercise parameters DM
aerobic: 3-7 days/week intensity: 50-80% VO2R or 12-16 RPE 20-60 mins large muscle groups resistance: 2-3 days/week with 48 hours break 2-3 sets of 8-12 reps at 60-80% of 1RM contraindications for diabetic retinopathy
43
BMI normal
18.5-25
44
BMI moderately obese (class 1)
30-35 > 30 = obese
45
BMI overweight
25-30
46
obesity exercise parameters
F: =/> 5 days/wk I: moderate (40-60% HRR), vigorous (50-75% HRR) T: 30-60 mins T: aerobic physical activity involving large muscle groups
47
obesity modalities precaution
risk of overheating - precaution with thermomodalities
48
HIV
virus that attacks the immune system, T cells with CD4 receptors transmitted by BLOOD, BREAST MILK, semen and vaginal secretions, CSF not transmitted by: SALIVA, FECES, URINE, SWEAT, TEARS
49
HIV universal precautions
use gloves if coming into contact with blood,body fluids, mucous membranes, or non-intact skin refrain from patient care if you have an open wound/skin lesion
50
AIDS
advanced HIV progression CD4 count < 200 1+ of 26 indicator conditions present
51
interventions AIDS
Highly active antiretroviral therapy (HAART) lifelong commitment PT = energy conservation, pain/symptom management managing deconditioning, weakness, fatigue, ROM, aerobic, resistance
52
peripheral neuropathy pattern HIV/AIDS
distal to proximal symmetrical
53
Fibromyalgia Syndrome
widespread chronic pain and increased pain response to pressure F>M during reproductive years 15-40 age
54
Fibro s/s
chronic widespread pain allodynia headache fatigue sleep disturbance cognitive dysfunction "fibro fog" anxiety and/or depression IBS
55
fibro tender points (ACR 1990)
widespread chronic pain > 3 months affecting all 4 quadrants tender points: NOTHING BELOW KNEE! occiput low cervical traps supraspinatus 2nd rib at costochondral junction lateral epicondyle gluteal greater trochanter medial knee
56
Lymphedema (primary vs secondary)
abnormal accumulation of lymph in tissue spaces primary: congenital malformation/insufficient development of lymph system secondary: surgical dissection of lymph nodes, inflammation/infection, obstruction or fibrosis, chronic venous insufficiency
57
Lymphedema interventions
manual lymphatic drainage compression - low stretch bandage, compression garments elevation, AROM, stretching, low-intensity cardiopulm. + resistance ex's
58
lymphedema CDT (complex decongestive therapy) program
phase 1: manual lyphatic drainage, multiple layer low-stretch compression bandaging 23hrs/day, exercise, skin and nail care, CDT 4-5x/wk @ 1hr phase 2: self-manual lymphatic drainage 20 mins/day, compression garment during the day with multiple layer bandage low-stretch at night, exercise, skin and nail care
59
pregnancy related back pain
worse with static postures or as day progresses relieved by rest/change of position COG shifts upward and forward increased lumbar and cervical lordosis increased anterior tilt scapular protraction and UE IR genue recurvatum at knees UPPER + LOWER CROSSED SYNDROME - tight hip flexors, extensors, suboccipital muscles and weak glutes and abs
60
pregnancy related back pain ex's
traditional low back ex's - core, post. pelvic tilt
61
pregnancy sleeping position
left side lying, flex knees, hips with pillow between knees supine with pillow under R pelvis and knees
62
pregnancy precautions + contraindications
precautions: heat (ligament laxity), laser (local) contraindications: deep heating - diathermy, electrical stimulation (local abdomen/low back), traction, ultrasound (local)
63
diastasis recti
abdominal separation at the linea alba > 2 finger widths or 2cm
64
diastasis recti s/s
low back pain reduced functional activity herniation if severe crook lying + raise head/shoulders to reach towards knees (+) = fingers sink into gap between rectus muscles
65
diastasis recti interventions
>2cm only head lift with pevlic tilt or TA activation without breath holding
66
transtibial amputation pros/cons
pros: increased potential for walking (own knee joint) with reduced energy expenditure cons: not a weight bearing end and bony prominences have potential risk of skin breakdown
67
transfemoral amputation pros/cons
pros: greater healing in avascular amputees cons: not a weight bearing end and less potential of ambulation with greater energy expenditure and external knee joint
68
rotationplasty
used to treat bone tumors in children part of the limb is removed and the remaining lower limb is rotated and reattached so the ankle can act as the knee joint
69
positioning for transtibial amputation
prevent knee and hip flexion contractures patient placed in prone with no pillow stump board for sitting in wheelchair
70
positioning for transfemoral amputation
prevents hip flexion, hip ER and abduction contractures patient in prone 15-20 minutes with neutral leg position, no pillows
71
amputations transfer
postsurgical leading with unamputated limb towards good side walkers provide greater stability, crutches provide greater mobility and help train balance in prep for prostethic supine to sit - slightly raise residuum + roll to good side and rise to sit
72
amputee strengthening considerations
strengthening on amputation side contraindicated in post surgical phase TF: strengthen hip ext, abd, and add for ambulation TT: hip ext/abd/add, knee extensors/flexors for ambulation
73
residual limb examination
shape normal = cylindrical, conical, bulbous end abnormal = dog ears, skin folds, edematous pain - sharp, sticking, or pressure at end of stump = improper fitting prosthesis
74
phantom limb sensation words
tingling, burning, itching, pressure, numbness or wetness
75
amputation prosthetic ambulation training
never use walker unless using before amputation, cane may be used smooth, energy-efficient gait as possible
76
pressure sensitive areas for WB transtibial
patella lateral tibial condyle tibial tuberosity tibial crest anterior-distal end of tibia fibular head distal end of fibula distal end of stump with surgical suture medial femoral condyle lateral femoral condyle
77
pressure sensitive areas for WB transfemoral
greater trochanter ramus anterior superior iliac spine adductor tendon distal end of femur inguinal fossa pubic tubercle surgical suture
78
red flags for cancer
night pain constant unrelenting pain unexplained weight loss loss of appetite unusual lumps/growths unwarranted fatigue bone pain that is worse at night cord signs history of cancer
79
common side effects of chemotherapy for PT
fatigue, neuropathies (contraindication for modalities, balance impairments, motor deficits) , chemo fog, nausea, vomiting, increased bruising due to reduced platelets cancer-related pain and cancer-related fatigue*
80
common side effects of radiation for PT
fatigue, myelosuppression, nausea, vomiting, local skin problems cancer-related pain and cancer-related fatigue*
81
cancer referral red flag
motor changes - report to oncologist (neurotoxicity)
82
PT cancer interventions
decrease pain - TENS (not over malignancy), cold pack, gentle mvmt, ex's decrease stress in bones - education on risks and protection strategies, splinting/bracing, assistive devices fatigue management - 5 P's!* planning, pacing, prioritizing, positioning, proficiency
83
cancer special considerations
exercise, strengthening and mobs contraindicated in pts with bone metastasis due to high risk pathological #'s minimize rotation with bone metastasis in vertebrae no modalities in cancer area unless palliative check sensation before modalities in case of peripheral neuropathy no creams, oils, topicals, chlorine over irradiated skin until approved alter, adapt, or delay treatments in blood counts are too low
84
hemophilia clinical symptoms
bruising from shots or lifting babies under arms/firmly holding excessive bruising from minor traumas delayed hemorrhage after minor injury persistently bleeding cuts hemarthrosis spontaneous bleeding into joints, muscles, organs
85
hemarthrosis
bleeding into joint space, affects synovial joints target joints = recurrently bleeding joints knee most common, ankle, elbow, hip, shoulder, wrist swelling, stiffness, pain and warmth chronic inflammation from blood may cause joint erosion of cartilage
86
management of active bleed - Acute stage
pain meds - no aspirin/ibuprofen RICE pain-free movement non/minimal WB (crutches) splinting and support
87
management of active bleed - subacute stage
progressive weight-bearing, mvmt and ex's wean from splints and slings
88
management of active bleed - musle
RICE progressive movement appropriate WB
89
hemophilia post-bleed rehab
effects of exercise - increased strength, ROM, joint protection, clotting factor, and temperature isometric ex's slow progression to strengthening ex's when full pain-free ROM in joint slow, progressive return to weight-bearing activites proprioception ex's
90
hemophilia rehab considerations
heat contraindicated during active bleed joint mobs contraindicated always no contact sports no activities with high injury risk heavy weight lifting and eccentric loading not recommended

physio (9 decks)

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