Multisystems Flashcards
What is thrombocytopenia?
- What platelet levels indicate the different level of function and exercise?
- At what level is exercise contraindicated?
- What level is there risk of spontaneous bleed?
- What level requires a doctors approval for exercise?
THROMBOCYTOPENIA
Low platelet count (normal = 150-400,000/mcL)
- Increased risk of bruising or bleeding (report any unusual bruising or symptoms to MD)
If <50,000 MCL = avoid activities with contact or risk of falling
- RX = 40-60,0000 MCL
- -> low weights (1-2 lbs), stationary bike low resistance, walking or ADLs
- RX = 20-40,0000 MCL
- -> low intensity exercise, low weights (0-2 lbs), stationary bike no resistance or minimal, walking, and ADLS
If <20,000 MCL = Incr risk of spontaneous bleed unrelated to trauma
- RX = 10-20, 0000 MCL
- -> doctor approval, active ROM exercises, walking, ADLS (may need supervision)
If <10,000 MCL = spontaneous CNS, GI, or respiratory tract bleeding may also occur
- RX = <10, 000 MCL
- -> no exercise, only essential ADLs, prevent falls and injury
What is the diagnostic criteria for Rheumatoid Arthritis (RA)?
RA CRITERIA:
- morning stiffness >1hr (6 weeks)
- arthritis of ≥ 3 joints (6weeks)
- arthritis of hand joints
- symmetric arthritis (6weeks)
- rheumatoid nodules
- serum rheumatoid factor
- radiographic changes
- abnormal antibody HLA-DR4 (80% those w/ RA)
- -> also found in pts with interstitial lung disease, chronic hepatitis, idiopathic pulmonary fibrosis, normal aging adults, SLE
What is the pathophysiology of RA?
RHEUMATOID ARTHRITIS
MAIN FEATURE –> SYNOVITIS –> symmetrical pattern
- Synovium becomes swollen and cells proliferate, creating a dense cellular membrane (pannus) spreads over articular cartilage
- Eerodes underlying cartilage and bone
- W/ time –> pannus may extend to the opposite articular surface creating:
1) fibrous scar tissue
2) adhesions
3) bony ankylosing
LEADS TO:
- Immobility + consolidation (bones form a single unit) of a joint
- Bones can become osteopenic
- Ligaments/tendons become damaged or ruptured
- Surrounding mm deteriorate = joint instability + deformity prone
What is the difference between a Cam and a Pincer lesion with FAI?
FEMORAL ACETABULAR IMPINGEMENT
TYPES
Cam
- Decreased/absent waist of the jx of femoral neck and head
- W/ hip flex = abnormal femoral head drives into acetabulum
- Young men
Pincer
- Abnormal acetabulum provides excessive cover of femoral head
- Retroverted or deep acetabulum
- Impingement when femoral neck pushes against overarching acetabulum
- Women 30-40 years
Differentiate between bouchard and herbenens nodes
- What condition does this occur in?
Hand//
- PIP is Bouchard node,
- DIP is Hebernen’s node;
In OA –> osteophytic growth
What is Ankylosing Spondylitis (aka Marie-Strumpell disease)?
- What is the hallmark sign?
Ankylosing Spondylitis (aka Marie-Strumpell disease)
o stiffness/fusing of the spine by inflammation, disease of young adults
o Associated with genetic marker HLA B27
o Features: MSK-sacroiliitis, enthesitis, synovitis; other signs-eyes, bowels, lungs, heart
o The hallmark sign is sacroiliitis; may also feel deep, dull pain in buttock area d/t inflammation of SI joint; fusion can occur over time
o Enthesitis - inflammation of entheses leading to bony erosion and overgrowth (entheses = where tendons, ligs, and joint capsule attach to bone)
Common sites are spine, hip, peripheral regions; syndesmophytes (bony spurs on 2 sides of a joint) can also cause bony fusion and rigidity
o Synovitis - usually affects peripheral jts, commonly shoulders, hips, knees, ankles
What is the clinical criteria for diagnosing AS
CLINICAL CRITERIA
- LBP + stiffness for more than 3 months
- Improves with ex, worse with rest
- AM stiffness
- Altered posture/muscle imbalances = deformities/instability
- HFP, thoracic kyphosis, flattening of anterior chest wall, protrusion of abdomen, flattening of lumbar lordosis, slight hip flex
- Decreased strength = deconditioning
- Decreased L-spine ROM in sagittal + front planes = flexion posture d/t pain, tissue contractures, mm guarding, fusing
- Altered breathing mechanics = decr chest expansion compared to normal values –> diaphragmatic breathing pattern and decr vital capacity
- Fatigue d/t disease process
Give a brief overview of Ankylosing Spondylitis?
- Onset
- Meds
- Diagnosis
- PT goals
- Physical assessment
Quick overview:
- Onset before 40, low back pain, sacroiliitis, kyphotic deformitiy Csp, Tsp, dec lumbar lordosis, M>F
- Meds: NSAIDS, corticosteroids, cytotoxic, tumor necrosis factor
- Diagnosis – HLA-B27
- PT goals: trunk flexibility, endurance, increase resp function (relaxation)
- Physical Ax - posture (tragus to wall), lateral trunk flexion, trunk flexion (modified schobers), trunk extension (smythe test), trunk rotation, chest expansion, cervical mobility
What is the treatment for spondyloarthritis
- Medical
- Physical therapy
- Outcome measures
Spondyloarthritis Rx:
- Meds- DMARDs, NSAIDs, corticosteroids, biologics
- Physical Management- control/decrease inflammation, P management, reduce stiffness/increase ROM, posture correction, increase mm strength and endurance, increase cardio
- Rx: maintain joint mobility with exercise, stretching, heat, and postural instruction/re-education
Outcome measures
- BASFI (impact of disease on fxn in last week)
- BASDAI (how disease is managed)
What is Enteropathic spondylitis?
ENTEROPATHIC SPONDYLITIS
Related to:
Inflammatory conditions of the bowel (cause diarrhea):
- Ulcerative colitis (affects lower half of bowels)
- Crohn’s disease (affects whole digestive system = worse)
Incr bowel disease = incr arthritis
Can also affect = Spine, SI joint, limb joints
Exercise in OA and RA
- Contraindications and red flags
- Precautions
EXERCISE IN RA AND OA
RA = primarily affects MCP + PIP, rheumatoid cachexia (breakdown of muscle fibres), fatigue!!!
OA = affects weight bearing joints hip, spine, DIP, PIP, first CMC, first MTP
BOTH BENEFIT FROM - aerobic, resistance, and stretching/ROM = pool is great for both
- Follow ACSM general but based on individual pat presentation
CONTRAINDICATIONS/RED FLAGS
o Incr pain, fatigue or AM stiffness
o sudden pain at joint or joint deformity
o joint becomes red, swollen and hot after doing exercise (within 24 hrs)
o Decr muscle strength and function (local myositis)
o neurological SSx (CV involvement)
o SOB on mild exertion
PRECAUTIONS
o watch out for inappropriate exercise = can harm joints (RA = deforming forces)
o swollen joints at risk for capsular stretch and rupture
o OP bone at risk for #
o use machine and resistance bands rather than free weights
Differentiate between T1DM and T2DM
DIABETES TYPE I
o juvenile onset
o require insulin
o immune mediated attach of islet cells in pancreas
o decreased circulating insulin
o PRESENTATION:
= weight loss, incr urination, dehydration
DIABETES TYPE II
o adult onset
o don’t need insulin = b/c doesn’t respond to it
- causes insulin resistance in peripheral tissues (don’t respond to insulin)
o PRESENTATION:
- obese
- acanthosis nigricans (hyperpigmented skin in axilla, groin, back of neck)
- HTN
NORMAL GLUCOSE LEVELS
o fasting plasma glucose: 5.6 mmol/L, diabetes >7 mmol/L
o impaired fasting plasma glucose : >5.6 mmol to <7 mmol/
Differentiate between Hypo and Hyperglycemia;
- What are some of the long term effects of hyperglycemia?
HYPOGLYCEMIA
o dizzy, nausea, weak, sweating profusely (this rules out orthostatic hypotension)
o fatigue, irritability, confusion, fainting
HYPERGLYCEMIA
o blurred vision, fatigue, thirst, frequent urination, weakness, abnormal breathing, acetone breath
o LONG TERM EFFECTS
- damage to small blood vessels (retinopathy and diabetic nephropathy)
- damage to large blood vessels = abnormal glucose metabolism causes increased cholesterol levels = vessel wall damage = atherosclerosis and myocardial infarction, stroke, gangrene
- damage to peripheral nerves = diabetic neuropathy
What are the considerations for physical therapy for a diabetic patient?
RX
- regular exercise = very important
- talk to MD about insulin levels for exercise
- have snack before (have raisins/juice available to boost sugar levels if necessary)
- monitor blood sugar levels pre, during, and post exercise
- avoid exercise at night = person may go to sleep and slip into a hypoglemic coma and die
- PT always monitor pt for SSx hyper or hypoglemia
