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Physiotherapy 2.3 > PTA > Flashcards

PTA Flashcards

1
Q

What are the different forms of Asthma?

A
  • Allergic
  • Non-allergic (exercise induced etc)
  • Late onset asthma (in adult life)
  • With fixed air flow limitation (due to airway remodelling)
  • With obesity
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2
Q

How many people in NL suffer from Asthma?

A

1.8 million

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3
Q

Is Asthma more prevalent in men or women?

A

Women

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4
Q

What does IgE in Asthma stand for?

A

Immunoglobulin E
(an antibody generated by the immune system in response to a harmless stimulus)

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5
Q

What happens during the first contact with an allergen in Asthma?

A
  • IgE production by eusoniphil leucocytes starts
  • IgE attaches to mast cell

→ No symptoms

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6
Q

What happens during the second contact with an allergen in Asthma?

A
  • Allergen binds to IgE molecules (which are now attached to mast cell)
  • Mast cell gets activated/degranulated
  • Histamine is released → causes allergic reaction
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7
Q

What are the characteristics of a non-allergic asthmatic reaction?

A
  • Non-specific stimulus like effort, smoke, dust, fog, cold, viral infection, stress is present
  • Degranulation of mast cell and release of histamine without involvement of IgE
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8
Q

Exercise-induced bronchoconstriction is the case in?

A

Exercise induced asthma

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9
Q

What can absence of wheezing in asthma patients indicate?

A

Exacerbation! Silent chest

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10
Q

How can asthma best be treated?

A

Minimising future risk of:
- Exacerbation
- Fixed airflow limitation
- Side-effects of medication

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11
Q
  • Immediately decreased risk of cardiorespiratory problems by 50%
  • Decrease of cholesterol after 1 week
  • Decrease of blood pressure by 10mmHg
  • Decrease of pulse by 10-25 bpm
  • Decreased risk of infection
  • Decrease in adrenaline production

These are benefits of eliminating which risk factor?

A

Smoking

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12
Q

The risk for cardiac pathology equals non-smokers when?

A

2-3 years after quitting smoking

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13
Q

Cholesterol decrease of 10% lowers the risk of cardiac pathology by?

A

20%

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14
Q

Total cholesterol should be?

A

190mg/dL or 5mmol/L or below

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15
Q

LDL should be?

A

150mg/dL or 3,9mmol/L or below

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16
Q

HDL should be?

A

At least 45mg/dL or 1mmol/L

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17
Q

What are benefits of a normal blood pressure?

A
  • Decreased risk of cardiovascular pathology
  • Decreased risk of kidney problems
  • Decreased risk of stroke
  • Decreased load on the heart
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18
Q

Goals of cardiac rehab are?

A

→ Prevention / treatment of pulmonary complications

→ Treatment of risk factors

→ Improve and maintain exercise capacity

→ Improve quality of life

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19
Q

What are the phases of cardiac rehab?

A
  • Preoperative phase
  • Phase 1 or clinical phase
  • Phase 2 or rehabilitation phase
  • Phase 3 or post-rehabilitation phase
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20
Q

When does the preoperative phase of cardiac rehab start?

A

4 weeks before surgery

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21
Q

What is the frequency and duration of sessions in the preoperative phase of cardiac rehab?

A

7 days per week

20min per session

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22
Q

What aspects are trained in the preoperative phase of cardiac rehab?

A
  • Inspiratory muscle training (IMT) with threshold device
  • Breathing exercises
  • Airway clearance techniques
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23
Q

Which patients have to do the preoperative phase of cardiac rehab?

A

Open heart surgery patients
(coronary artery bypass grafting CABG and/or valve replacement)
→ with increased risk of developing pulmonary complications post-operative

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24
Q

When does phase 1/clinical phase of cardiac rehab start?

A

Immediately after acute cardiac event

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25
Q

What are the main compartments of phase 1/clinical phase of cardiac rehab?

A
  • In acute phase → relative rest with pulmonary physiotherapy
  • Afterwards mobilisation phase at the hospital
  • Dynamic mobilisation as early as possible
  • Gradual build up and inclusion of ADLs like walking and stair climbing
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26
Q

When can you progress to phase 2/rehabilitation phase of cardiac rehab?

A

→ Patient is able to execute the intended ADLs (also with assistance)
→ Moderate exertion (3-4 MET) is possible
→ Patient has some knowledge of the heart disease
→ Patient is able to cope with condition and can increase ADL capacity

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27
Q

Where does phase 2/rehabilitation phase of cardiac rehab take place?

A

Almost always out-patient

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28
Q

What are the main components of phase 2/rehabilitation phase of cardiac rehab?

A

→ Practice functional skills
→ Develop enjoyment of exercise
→ Improve aerobic endurance
→ Improve strength and strength endurance

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29
Q

How often should strength training and endurance training be applied in phase 2/rehabilitation phase of cardiac rehab?

A

2-3 times per week EACH

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30
Q

What are the main characteristics of phase 3/post-rehabilitation phase of cardiac rehab?

A
  • Carried out outside of institutional health care
  • Focus on maintaining active life style initiated in phase 2
  • Patient maybe advised to join exercise programme in primary care
  • Check up 6-12 months after phase 2 has ended
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31
Q

Which scales can be used in cardiac patients?

A

Dyspnea scale
Borg scale
Angina pectoris scale

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32
Q

What are the 4 classes on the angina pectoris scale?

A

Class 1 - Angina only during strenuous and prolonged physical activity

Class 2 - Slight limitation, with angina only during vigorous physical activity

Class 3 - Moderate limitation, angina symptoms in ADLs

Class 4 - Severe limitation, inability to perform any activity without angina or angina at rest

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33
Q

What is the range of the dyspnea scale?

A

0-10

0 = nothing at all

10 = maximal

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34
Q

What are main characteristics of atherosclerosis?

A
  • Not the same as arteriosclerosis
  • Accumulation of fat-like substances, CT and calcium on inner wall (endothelium) of artery → Atheroma
  • Accumulation of LDL → low-density lipoprotein, HDL can reduce this (high-density lipoprotein
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35
Q

How does atherosclerosis develop?

A

→ Nitric oxide (NO) is synthesised to protect endothelium against accumulation of fat

→ Increased consumption of bad saturated fat increases oxidative stress and inhibits protective function of NO

→ Plaque accumulates

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36
Q

What can be typical consequences of atherosclerosis?

A

Thrombosis

Infarction

Aneurysm

Pulmonary Embolism

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37
Q

What are typical symptoms of an infarction?

A

→ Tight and pressing pain in the centre of the chest
→ Possible radiation to arm, neck, jaw, back or stomach
→ Sweating, nausea, vomiting

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38
Q

What is the mechanism of pulmonary embolism?

A
  • Thrombus/embolus gets trapped in small vessel
  • Repetitive embolisms lead to reduction in pulmonary vascular bed
  • Pulmonary hypertension develops
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39
Q

What are typical symptoms of pulmonary embolism?

A

→ Shortness of breath (dyspnoea)
→ Pain with sighing and coughing
→ In combination with emphysema → pulmonary infarction

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40
Q

Dilated veins due to valve disfunction
→ Blood flows back

What is the clinical term for this?

A

Varicose Veins

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41
Q

What are typical symptoms of varicose veins?

A

→ Visible tangle of barrels

→ Brown discolouration of skin

→ Swelling of lower leg/ankle (especially after long periods of standing)

→ Lying reduces pressure and swelling

→ Not painful but uncomfortable

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42
Q

How high is the percentage of muscle mass in the body weight of elderly?

A

25%

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43
Q

What does the TFI (Tilburg Frailty Index) assess?

A
  • Identify fragility at early age → earlier help
  • Physical, psychological and social health
  • Mapping fragility

→ Increase quality and effectiveness of health care

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44
Q

When does functional ageing often start?

A

65 years

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45
Q

How many hours a day are elderly >70 usually sedentary?

A

10h per day

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46
Q

What are the 5 geriatric giants?

A

→ Falls
→ Incontinence
→ Confusion
→ Impaired homeostasis
→ Iatrogenic disorders (e.g. polypharmacia)

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47
Q

6% loss of muscle mass and 16% loss of strength in elderly are the result of?

A

10 days of bed rest

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48
Q

What is the definition of polypharmacy?

A

Use of at least 5 different drugs for different conditions over long period of time

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49
Q

Which tool can be used to assess delirium in elderly?

A

Use DOS-scale (Delirium Observation Screening)

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50
Q

What is the top injury after a fall in elderly?

A

hip fracture (17%)

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51
Q

Tinetti Test
Short Physical Performance Battery (SPPB)
Timed Up and Go Test (TUG)
De Morton Mobility Index (DEMMI)
Handgrip Strength Test
Berg Balance Scale
6 Minute Walk Test

What can these clinimetric tools be used for?

A

Assessment of functional capacity of elderly

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52
Q

Which point range indicates high risk of falling in the Tinetti Test?

A

≤ 18 points

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53
Q

What does the DEMMI assess?

A

Mobility and balance in bed, sitting, standing, walking and in dynamic motions

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54
Q

What does the Short Physical Performance Battery (SPPB) test?

A

gait speed, sitting to standing and balance

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55
Q

65% of Class 4 heart failure patients die within?

A

12 months

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56
Q

50% of Class 2-3 heart failure patients die within?

A

5 years

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57
Q

What is the general principle of heart failure?

A
  • Inability to pump the blood through the body properly
  • Usually because heart has become too weak or stiff
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58
Q
  • Myocardial infarction
  • High blood pressure
  • Heart diseases (rhythm disorder, valve disorder, poor blood flow, cardiomyopathy)
  • Coronary artery disease
  • Diabetes mellitus
  • Atherosclerosis → Cause for heart attack
  • Valve inefficiency → Blood flows back

What can all of these pathologies cause?

A

Heart failure

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59
Q

What causes shortness of breath in heart failure patients?

A
  • Fluid/oedema in the lungs
  • Arteries in the lungs are under high pressure and fluid gets into the lung tissue
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60
Q
  • Shortness of breath
  • Fluid/oedema in the lungs
  • Arteries in the lungs are under high pressure and fluid gets into the lung tissue
  • Fatigue
  • Oedema (ankles)
  • Forgetful
  • Poor concentration
  • Cold hands
  • Poor sleep
  • Having to urinate more often during night (build up of fluid in the body)
  • Attacks of shortness of breath and coughing when lying flat
  • Slow recovery after physical effort

These are typical symptoms of?

A

Heart failure

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61
Q

Why is sudden weight gain important to check in heart patients?

A

Holding of fluid/water in the body -> can indicate heart failure

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62
Q

What are red flags in heart failure patients?

A
  • Serious cognitive problems
  • Weight gain of > 3kg within a few days, wether or not accompanied by dyspnea at rest
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63
Q
  • No limitations in any activities
  • No symptoms in ordinary activities
  • VO2max > 20ml/kg/min
  • MET > 6
  • Watt (intensity) > 100

Which heart failure classification according to NYHA is that?

A

Class 1

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64
Q
  • Slight limitations in physical activities
  • Comfortable at rest
  • Symptoms during moderate physical activity
  • VO2max 15-20ml/kg/min
  • MET 4-6
  • Watt (intensity) 60-100

Which heart failure classification according to NYHA is that?

A

Class 2

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65
Q
  • Marked limitation of physical activity
  • Minor activities result in symptoms
  • VO2max 10-15ml/kg/min
  • MET 3-4
  • Watt (intensity) 30-60

Which heart failure classification according to NYHA is that?

A

Class 3

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66
Q
  • Severe limitation of physical activity
  • Symptoms at rest
  • VO2max < 10ml/kg/min
  • MET < 3
  • Watt (intensity) < 30

Which heart failure classification according to NYHA is that?

A

Class 4

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67
Q

What MET score is walking?

A

3

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68
Q

What MET score is watching TV?

A

1.5

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69
Q

What MET score is cycling at 12kmh?

A

5

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70
Q

What are the main therapy goals of heart failure treatment?

A

→ Maintain condition as good as possible

→ Loose weight (decrease cardiac load)

→ Minimise salt ingestion

→ Restriction of fluid (< 2l per day)

→ Stop smoking

→ Limit alcohol consumption

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71
Q

Which heart failure medication is taken to reduce the pre-load of the heart?

A

Diuretics like Furosemide, Hydrochlorthiazide

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72
Q

Which heart failure medication is taken to reduce the after-load of the heart?

A

ACE-inhibitors, vasodilators

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73
Q

Which medication is used for heart failure patients to increase heart contraction force?

A

Digitalis -> Digoxin

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74
Q

First endurance or interval training in heart failure patients?

A

First Interval then endurance

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75
Q

What are the endurance session parameters for heart failure patients with VO2max below 17.5ml?

A

2x 15min sessions per day

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76
Q

How is interval training for heart failure patients build up?

A

→ 4 x 4min of 80-90% of VO2peak

→ Active recovery 3min of 40-50% of VO2peak in between sets

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77
Q

At what frequency should inspiratory muscle training (IMT) be used in heart failure patients?

A
  • 15-20min
  • 3-4 times a week
  • 8-12 weeks consecutively
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78
Q

Which heart failure patients should use IMT as an adjunct?

A

For class II-III with PImax < 70% of predicted value or ventilatory limitations

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79
Q

How is the 1RM in heart failure patients determined?

A

calculate 10RM

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80
Q

What are the normal strength training parameters for heart failure patients?

A
  • Gradual increase from 40% to 65% of 1RM
  • Train large muscle groups

→ 2-3 times a week, 2-3 sets, 10-15reps

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81
Q

How long does the pre-training period for strength training in heart failure patients take and what are the parameters?

A

2 week pre-training period

→ 2-3 sets, 10 reps, < 30% of 1RM

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82
Q

→ Venipuncture
→ Limb constriction
→ Limb elevation
→ Heat/cold application or surrounding
→Air travel and use of compression garments when travelling by air

Is there weak or strong evidence that the above provoke or treat lymphoedema?

A

Weak evidence

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83
Q

What are good ways to prevent lymph oedema according to research?

A

→ Maintaining a normal body weight, normal BMI
→ Participation in supervised exercise programme

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84
Q

What are the 3 types of oedema?

A

→ Venous oedema

→ Lip-oedema

→ Lymphoedema

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85
Q

→ Painful, swollen feelings in the legs
→ Cold feeling
→ Increasing complaints during the day
→ Tiredness
→ Foot, knee and hip complaints

These are typical symptoms of?

A

Lip-Oedema

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86
Q
  • Large amounts of irregularly distributed fat
  • Mainly hips, thighs and lower legs
  • Mainly women affected
  • Heredity may play a role

These are typical characteristics of?

A

Lip-Oedema

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87
Q

→ Heavy, restless feeling in the legs
→ Swollen ankles and legs
→ Varicose veins
→ Eczema: Brown or white skin discolouration

These are typical symptoms of?

A

Venous Oedema

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88
Q
  • Faulty valves in veins
  • Impaired return of oxygen-poor blood from legs to heart

These are typical characteristics of?

A

Venous Oedema

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89
Q

→ Swelling
→ Fatigue and heaviness
→ Pain
→ Limitations in movement and daily functioning
→ Skin abnormalities and infections

These are typical symptoms of?

A

Lymphoedema

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90
Q
  • Abnormal accumulation of tissue fluid
  • Malfunction of lymph system:
  • Too little vessels
  • Damage of lymph vessels or nodes
  • Overload of lymph system

These are typical characteristics of?

A

Lymphoedema

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91
Q
  • Clothes, jewellery and watches become too tight
  • Increasing unilateral or bilateral limb circumference
  • Dimple in skin after pressure
  • Differences in skin thickness

These are good ways to recognise?

A

Oedema

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92
Q

What are risk factors for oedema?

A
  • Inactivity
  • Obesity
  • Infections (erisepelas)
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93
Q

What are typical causes for oedema?

A
  • Lymphatic system
  • Blood vessels
  • Fat
  • Heart
  • Kidneys
  • Genetic factors

→ Often a combination

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94
Q

How much percent of yearly deaths worldwide are related to NCDs?

A

71%

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95
Q

How much percent of all yearly NCDs related deaths are due to high BP?

A

12.8%

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96
Q

What is the cut off for high BP?

A

140/90mmHg

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97
Q

What is a normal cholesterol level in the blood?

A

5.0mmol/L or 190/200mg/dL

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98
Q

Which cholesterol level increases the chances of atherosclerosis by 4 times?

A

> 8.0mmol/L or 300mg/dL

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99
Q

How much does co-smoking increase the risk of lung cancer or cardiovascular diseases ?

A

20-30%

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100
Q

What is a normal blood sugar level?

A

4.0-8.0mmol/L or

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101
Q

What are typical symptoms of Hypoglycaemic?

A

→ Sleepiness
→ Sweating
→ Pallor
→ Lack of coordination
→ Irritability
→ Hunger

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102
Q

What are typical symptoms of Hyperglycaemia?

A

→ Dry mouth
→ Increased thirst
→ Blurred vision
→ Weakness
→ Head ache
→ Frequent urination

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103
Q

What is the optimal body fat % for men and women?

A

Men <20%
Women <30%

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104
Q

What is the optimal waist size for men and women?

A

Men <102cm
Women <88cm

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105
Q

What is the optimal BMI?

A

18.5 - 24.9

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106
Q
  • Increase of HR and BP
  • High caloric density
  • Increased risk of cancer
  • Negative effects on fats and HDL
  • Production of toxins in liver (acetaldehyde)
  • Negatively effects BP drugs
  • Bad eating habits

These are negative effects of consuming?

A

Alcohol

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107
Q
  • Patients with heart failure
  • Patients with congenital heart defect
  • Patients with heart transplant
  • Patients with defribrillator (ICD) or pacemaker
  • Patients with arrhythmias
  • Patients with atypical thoracic pain complaints (heart anxiety)
  • Patients with resuscitation or cardiothoracic surgery
  • Patients with left ventricular assist device (LVAD)

These are relative or normal indicators for cardiac rehab?

A

Relative indicators

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108
Q
  • Based on coronary artery disease
  • Patients with acute coronary syndrome (ACS) (including infarction AMI and unstable angina pectoris)
  • Patients with stable angina pectoris
  • Patients who have undergone percutaneous coronary intervention (PCI)
  • Patients who have undergone coronary artery bypass grafting (CABG) or valve surgery

These are relative or normal indicators for cardiac rehab?

A

Normal indicators

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109
Q

Psychological stress can cause?

A
  • Fatigue
  • Pain
  • Decreased motor control
  • Decreased blood flow in the muscles
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110
Q

What are synonyms for sPAD (Symptomatic Peripheral Arterial Disease)?

A

“Intermittent Claudication”

“Window Shopping Disease”

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111
Q

How many people over 55 suffer from sPAD worldwide?

A

19% (200 million worldwide)

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112
Q

What is the life expectancy with sPAD?

A

< 10 years

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113
Q
  • Narrowed arteries due to plaque (especially at branches)
  • Endothelial membrane impaired
  • Insufficient oxygen supply to muscles

This is the typical mechanism of which disease?

A

sPAD

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114
Q
  • Pain in lower extremities distal to stenosis
  • Walking provokes pain
  • Standing and pausing reduces complaints
  • Skin defects
  • Colour and/or temperature differences
  • Muscle weakness
  • Sensory disorders

These are typical symptoms of?

A

sPAD

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115
Q

According to Fontaine sPAD can be categorised in?

A

5 classes

I - Asymptomatic

IIa - Mild claudication

IIb - Moderate to severe claudication

III - Rest pain

IV - Ulceration or gangrene

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116
Q

According to Rutherford sPAD can be categorised in?

A

7 classes

0 - Asymptomatic

1 - Mild claudication

2 - Moderate claudication

3 - Severe claudication

4 - Rest pain

5 - Minor tissue loss

6 - Severe tissue loss or gangrene

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117
Q
  • Walking Impairment Questionnaire (WIQ)
  • Cumulative Illness Rating Scale (CIRS)
  • Quality of Life (EQ-5D)
  • BORG-scale
  • ACSM-scale
  • Perceived Stress Scale (PSS)

These are typical clinimetric tools for the assessment of?

A

sPAD

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118
Q

What is the protocol of the graded treadmill test for sPAD?

A
  • Speed at 2mph or 3.2kmh
  • Start with altitude of 0°
  • Increase altitude by 2° every 2 minutes → Until 10° is reached
  • Max duration of test 30min
  • Note time and distance:
    → when patient wants to stop (functional walking distance)
    → when patient has to stop (max walking distance)
  • Use ACSM score
  • Use as evaluative tool in treatment
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119
Q

What is the ACSM score in the assessment of sPAD?

A

Grade 1: Light discomfort or onset of pain on modest level (present, but minimal)

Grade 2: Moderate discomfort or pain of which the patient’s attention can be diverted (e.g. by conversation)

Grade 3: Intense pain (almost grade 4) from which the patient’s attention can’t be diverted

Grade 4: Excruciating and unbearable pain

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120
Q

What does ACSM stand for?

A

American College of Sports Medicine

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121
Q

What is the outcome of the ABPI/ABI - Ankle Brachial Pressure Index?

A

→ Dividing the systolic BP at dorsal pedis artery or posterior tibial artery (choose highest) by brachial BP

  • Normal ABI: 1.0-1.4 (pressure in ankle is normally higher than in arm)
  • ABI 0.9 or below? → Positive Test!!
  • ABI below 0.5? → Severe PAD
    → Insufficient blood flow to heal wounds
  • ABI above 1.4? → Calcification of blood vessel (diabetes or elderly people)
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122
Q

When is the ABI positive for sPAD?

A

0.9 or below

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123
Q

How long does the maintenance phase of sPAD rehab take?

A

40 weeks

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124
Q

How long does the start phase of sPAD rehab take?

A

4 weeks

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125
Q

How long does the self/training phase of sPAD rehab take?

A

8 weeks

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126
Q

How are objective limitations in sPAD reduced?

A

→ Maximise pain-free walking distance

  • ACSM of 3-4
  • Minimum 6 months → homework
  • 3x per week → homework
  • Each session 30min → homework
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127
Q

How are subjective limitations in sPAD reduced?

A
  • No pain no gain
  • Safe environment
  • Recognise limitations ion ADLs
  • Recognise and cope with cardiac limitations

→ Have fun being active!!!

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128
Q

What are the main goals of sPAD rehab?

A
  • Improve activities and participation
  • Reduce objective and subjective limitations
  • Reduce risk factors of arteriosclerosis
  • Education and promotion of healthy lifestyle
  • Improve quality of life
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129
Q

What happens after 3-6 months according to the stepped care model?

A

evaluation of treatment

Continue therapy or referral to surgeon

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130
Q

What is the KomPas Tool?

A

Tool for shared decision making

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131
Q

What are the main tasks of claudicationet or chronisch zorgnet?

A

treatment and monitoring of NCDs eg intermittent claudication

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132
Q

Autogenic training / self-hypnosis for relaxation was invented by?

A

Johannes Schultz

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133
Q

Relaxing the body by contracting and relaxing certain muscles are the key components of which technique ?

A

Progressive muscle relaxation by Jacobson

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134
Q

Which amount of smokers will develop COPD?

A

40-50%

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135
Q

How many COPD patients used to smoke or still smoke?

A

75%

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136
Q

COPD is slightly more prominent in men or women?

A

Men

137
Q

Which NCD will be No.3 cause of death by 2030?

A

COPD

138
Q

What are the 3 main causes for bronchial obstruction in COPD?

A

Bronchitis

Asthmatic bronchitis

Emphysema

139
Q

Main characteristic of bronchitis?

A

Hypersecretion of mucus

140
Q

Characteristics of asthmatic bronchitis?

A

Decreased airway diameter due to:
- Swelling of airway walls because of inflammation
- Contraction of smooth muscle in airway walls

141
Q

Characteristics of emphysema?

A

Collapse of airways due to:
- Loss of parenchyma
- Changes in intrapleural pressure

142
Q
  • Smoking
  • Exacerbations (acute in onset and requires change of medication)
  • Lower FEV1
  • Airway responsiveness
  • Comorbidities
  • Body weight
  • Dyspnea
  • Functional exercise capacity (6MWT)

These are prognostic factors for which disease?

A

COPD

143
Q

What increases the airway resistance in COPD?

A

Mucus plugs
Wall thickening
Oedema

144
Q

What is parenchyma?

A

The essential or functional elements of an organ.

145
Q

What is atelectasis in COPD?

A
  • Narrowing of airways leads to hyperinflation of alveoli
  • In case of total obstruction → atelectasis/collapse of the alveoli behind the obstruction

Atelectasis -> collapse of alveoli

146
Q

What is air trapping or hyperinflation in COPD?

A
  • A result of bronchial obstruction
  • Some air stays in the airways after expiration → Thorax stays in inspiration position
  • Leads to flattened diaphragm → less efficient contraction → functional weakening

-Leads to development of barrel chest

147
Q

What is hypercapnia?

A

A high arterial PCO2 (> 6kPA) -> high CO2 pressure

Often in COPD patients

Insufficient expiration accumulates CO2

148
Q

What is hypoxia?

A

A low arterial PO2 (< 8kPA) -> low O2 pressure

Often in COPD patients

Insufficient oxygen uptake and gas exchange

149
Q

What is cor pulmonale?

A

Right heart failure due to pulmonary insufficiency

Often seen in COPD

150
Q

How does pulmonary hypertension and eventually cor pulmonale develop?

A
  1. Circulatory system adapts to loss of alveoli in the lungs (no ventilation → shut down of circulation)
  2. Many capillaries are lost
  3. Increased resistance in pulmonary arteries due to lack of vessels
  4. Increased workload of right half of heart and hypertrophy of right ventricle
  5. Leads to overload and decompensation of right ventricle → right heart failure → Cor Pulmonale
151
Q

What is cyanosis?

A

Blue-ish skin due to lack of oxygenated blood supply

152
Q

What are the GOLD stages of COPD?

A

Mild -> FEV1 >80% of predicted

Moderate -> FEV1 50-80% of predicted

Severe -> FEV1 30-50% of predicted

Very severe -> FEV1 <30% of predicted

!!!All stages FEV1/FVC ratio < 0.7!!!

153
Q

What is the Hoover Sign in COPD?

A

→ Flattened diaphragm due to accumulation of fluid or air in intra-pleural space

→ Lower ribs are pulled inwards instead of upwards

→ Symmetric movement

154
Q

How many COPD patient profiles are there according to the KNGF guideline?

A

6 profiles

155
Q

Which COPD profiles show a mild to moderate symptom burden?

A

2, 3, 4, 5

156
Q

Which COPD profile shows a high symptom burden and exacerbations with hospitalisation?

A

Profile 6

157
Q

What does CCQ ≥ 1.9 and CAT ≥ 18 in COPD patients indicate?

A

High symptom burden

158
Q

What does CCQ 1 to 1.8 and CAT 10 to 17 in COPD patients indicate?

A

Mild to moderate symptom burden

159
Q

What does CCQ < 1.0 and CAT < 10 in COPD patients indicate?

A

No to low symptom burden

160
Q

Decreased capacity in COPD patients is closer related to lung function or overall strength?

A

Strength

161
Q

Which type of muscle fibres is decreasing in COPD patients?

A

Type 1 fibres due to decapillarisation

Decreases physical capacity

162
Q

Why does the FRC in COPD patients increase?

A
  • Loose lung recoil decreases
  • Balance between recoil (inward) and chest (outward) changes
  • More air stays behind
163
Q

Which questionnaires can be used to determine disease stability in COPD?

A

CCQ and CAT

164
Q

What are the best ways to decrease airway resistance in dyspnea?

A

Combination of bronchodilator and rehab has best results

165
Q

Inspiratory muscle training is recommended for which type of patient?

A

patients < 70% of predicted respiratory muscle function

GOLD stages II - IV

166
Q

What are the FITT factors for inspiratory muscle training?

A
  • Frequency → 5x per week, 1-2x daily, min. 4 weeks
  • Intensity → 30-50% of Pi,max
  • Type → 30x fast and deep inhalations (in/out 1:2 or 1:3)
  • Time → Approx. 5min
  • Short breaks after 10 breaths are possible
167
Q

How can the Pi, max in men and women be calculated?

A

142 - (1.03 x age) -> men

-43 + (0.71 x height in cm) -> women

168
Q

How does pursed lip breathing help in COPD and/or dyspnea?

A

Expiration is longer

Pursed lips create internal pressure that keep the airways open

Air can be expelled from alveoli

169
Q

Which patients might benefit from oxygen supplementation?

A

Drop of saturation by 4% in exercise test

170
Q

How does the oxygen saturation / SpO2 need to be to be allowed to start exercising

A

Resting SpO2 has to be above 90%

171
Q

Oxygen drops below 85% and no supplementation yet. This is an indication for what?

A

Contact GP

Stop exercising

172
Q

What is the FEV1 in spirometry?

A
  • Forced Expiratory Volume in 1 second
  • Total volume of air that patient is able to forcibly exhale within 1 second
173
Q

What is the FVC in spirometry?

A
  • Forced Vital Capacity
  • Total volume of air that can be exhaled forcibly in one breath
174
Q

What is the MVV and how can it be calculated?

A

Maximal voluntary ventilation = 37.5 x FEV1

175
Q

How can the ventilatory reserve be calculated?

A

MVV - VE (minute ventilation)

176
Q

What is a normal FEV1/FVC ratio?

A

0.7 - 0.8

177
Q

What does an FEV1/FVC ratio of < 0.7 indicate?

A

Obstruction!

Healthy elderly might have lower normal ratio -> over-diagnosing

Younger patients may have obstruction with ratio > 0.7 -> under-diagnosing

178
Q

How long can a full exhalation in COPD patients take?

A

approx 15sec

179
Q

What is the FEV6?

A
  • Forced Expiratory Volume in 6 seconds
  • Total amount of air that patient is able to exhale forcibly within 6 seconds
  • In healthy people FVC and FEV6 are most often identical
180
Q

When should interval training instead of endurance training be initiated in COPD patients?

A

Patient CANNOT continuously cycle in endurance test at 75% of maximal cycle load for 10 minutes consecutively

181
Q

At what intensity should endurance training be administered in COPD patients?

A

60-80% of max workload

182
Q

At what intensity should interval training be administered in COPD patients?

A

85-100% of max workload

183
Q

Which Borg score should you start with in endurance therapy for COPD?

A

4-6

184
Q

At which intensity do you start treadmill endurance training in COPD?

A

75% of 6MWT speed OR 40-60% of HRR or VO2max

185
Q

What are the parameters of strength training in COPD patients?

A

2-3x per week

60-80% of 1RM

2-5 sets, 8-15 reps (at least 2min breaks)

Large muscle groups

186
Q

Exercise therapy in COPD does not improve lung function TRUE or FALSE?

A

TRUE

187
Q

What are the recommendations of the guideline concerning mucus clearance in COPD?

A
  • Teach active breathing techniques to facilitate mucus clearance
  • If unable use active aids like:
    → Positive expiratory pressure (PEP)
    → Oscillating expiratory pressure (O-PEP)
  • Passive techniques like vibration or percussion are useless
188
Q

What does stasis of mucus lead to?

A

→ Problems in ventilation
→ Atelectasis
→ Lung infections

189
Q

What does hypertrophy of the mucus cells lead to?

A

thick and sticky mucus, blocking the airways

190
Q

What is the 2-Phase Gas-Liquid Stream in mucus clearance?

A
  • Shear stress between mucus and airflow in the air ways
  • Low air-flow → Little friction
  • High air-flow → More friction, turbulences in air flow which causes vibration
  • Higher air-flow during expiration than inspiration → mucus gets moved towards mouth and is cleared
191
Q

What are the main breathing techniques for mucus clearance?

A
  • Active Cycle of Breathing Technique
  • Stimulation of breathing movement (thorax excursion)
  • Forced expiration technique
  • Coughing
  • Huffing
  • Autogenous Drainage
192
Q

How does the Flutter help in mucus clearance and what type of tool is it?

A
  • Breathing through it builds pressure in lungs
    → Keeps airways open and helps air move behind mucus
  • Steel ball transmits vibrations through chest wall and helps loosen mucus
  • O-PEP device (Oscillating expiratory pressure)
193
Q

Forced expiration with open glottis. What is the term for this?

A

Huffing

194
Q

What are the 3 phases of autogenous drainage?

A

Unsticking

Collecting

Evacuating

195
Q

Which breathing technique consists of 3 different phases?

A

Autogenous drainage

196
Q

What is a different term for extension of the lungs?

A

Compliance

197
Q

What is a different term for shrinking of the lungs?

A

Elastic recoil

198
Q

What is the most popular definition of health literacy?

A

“The ability to understand and interpret the meaning of health information in written, spoken or digital form and how this motivates people to embrace or disregard actions relating to health”

199
Q

What is functional health literacy?

A
  • Understanding information
  • Understanding and following of instructions
  • Understanding of own health
200
Q

What is communicative health literacy?

A
  • Talk about own health
  • Standing up for one self
  • Asking the right questions
201
Q

What is critical health literacy?

A
  • Find reliable and serious information
  • Make informed decisions concerning health
202
Q

How many people that suffer from chronic disease suffer from 3 or more different ones?

A

27%

203
Q

What is the i3-S Strategy?

A
  • Innovative strategy for development of adaptations to exercise therapy related to co-morbidities
  • Often therapists scale down training because of co-morbidities which makes training ineffective
  • 4 steps, 3 inventory, 1 synthesis
204
Q

What does step 1 of the i3-S strategy assess?

A

Inventory of relevant co-morbid diseases

205
Q

What does step 2 of the i3-S strategy assess?

A

Inventory of comorbidity-related contraindications and restrictions on application of exercise therapy in index disease

206
Q

What does step 3 of the i3-S strategy assess?

A

Inventory of creating adaptations to exercise therapy

207
Q

What is step 4 of the i3-S strategy?

A

Synthesis of obtained information from previous steps

208
Q
  1. Rigorous assessment of health status
  2. Adaptation of exercise to co-morbidity
  3. Application and integration of behavioural change techniques into exercise plan
  4. Clinical reasoning to support the application of exercise by health professionals

What is described here?

A

The 4 principles of exercising with co-morbidities

209
Q

What is m-health?

A
  • Mobile health
  • Medical and public health practice supported by mobile devices
  • E.g. smartphone, personal digital assistants (PDA), wireless trackers etc.
210
Q

According to RTAUT model, the experience and will to use a technological device in health care as a patient is influenced by?

A

Personal features

Technology features

Social influence

211
Q

According to RTAUT model, the decision use of RT is influenced by?

A

Objective and subjective factors

212
Q

How many people between 60-70 suffer from diabetes?

A

10-12%

213
Q
  • Weight loss
  • Extreme tiredness
  • Increased hunger
  • Excessive thirst
  • Frequent urination
  • Tingling and numbness
  • Blurred vision
  • Unhealed wounds
  • Sweet urine (attracting ants)

These are typical symptoms of?

A

Diabetes Mellitus

214
Q

What are typical long-term effects of diabetes?

A
  • Retinopathy with potential blindness
  • Nephropathy → renal failure
  • Neuropathy → risk for ulcers, gangrene and amputation
  • Charcot joints
215
Q
  • Stimulates glucose uptake into muscle tissue and adipose cells
  • Inhibits hepatic glucose production
  • Inhibits break down of triglycerides
  • Inhibits ketogenesis
  • Inhibits protein degradation
  • Regulates gene transcription
  • Stimulates:
  • Aminoacid uptake
  • Proteinsynthesis

These are characteristics of which hormone?

A

Insulin

216
Q
  • Hyperglycaemia → Osmotic diuresis and dehydration
  • Elevated FAA levels (triglycerides in blood)
  • Ketoacidosis and ketone body production
  • Muscle waisting

Deficiency of which hormone leads to the above?

A

Insulin

217
Q

How many cases of diabetes are type 1?

A

5-10%

218
Q

How many cases of diabetes are type 2?

A

90-95%

219
Q

Absolute insulin deficiency because of pancreatic ß-cell destruction in islets of Langerhans
Which type of DM is that?

A

Type 1

220
Q
  • Begins as insulin resistance (often in overweight patients)
  • Insufficient insulin secretion in normal weight patients
  • Imbalance/disturbance of insulin sensitivity and secretion
  • Chronic hyperglycaemia
    Which type of DM is this?
A

Type 2

221
Q

When does gestational diabetes occur?

A

During pregnancy

222
Q
  • Uncommon
  • Thirst despite drinking large amounts and urinating
  • Abnormal function/levels of antidiuretic hormone (ADH) → limits urination
    Which pathology is this?
A

Diabetes insipidis

223
Q

Which fasting plasma glucose (FPG) level is indicative of DMT2?

A

→ 126mg/dL or higher (7mmol/L or higher) on 2 separate occasions
→ Measured being sober

224
Q

Which HbA1c is normal?

A

4%-5.6% is normal

Glycated haemoglobin

225
Q

Which HbA1c level is indicative for DMT2?

A

→ 6.5% or higher on 2 separate occasions
→ Glucose binds permanently to haemoglobin
→ Red blood cells live for 2-3months
→ Gives indication of glucose level over these past months

226
Q

When is the oral glucose tolerance test (OGTT) indicative of DMT2?

A

→ 2h past OGTT blood glucose is 200mg/dL or higher

227
Q

Fasting plasma glucose (FPG) is between 6.1mmol/L to 7 mmol/L

What does this indicate?

A

Pre-diabetes

228
Q

Impaired glucose tolerance (IGT) → 2h after intake of 75mg glucose, glucose level between 7.8mmol/L to 11.1mmol/L

What does this indicate?

A

Pre-diabetes

229
Q

HbA1c between 5.7% to 6.4%

What does this indicate?

A

Pre-diabetes

230
Q

Who should be checked for diabetes?

A
  • 45 years or older + overweight
  • 45 years or older but not overweight → Ask GP if test is required
  • Younger than 45 + overweight + risk factors for diabetes
231
Q

What is the ABC approach in DM treatment?

A

A: Diet and Exercise

B: Oral hypoglycaemic therapy

C: Insulin Therapy

232
Q

When should glucose lowering medication be administered in DM patients?

A

if it is not possible to achieve an HbA1cof ≤ 53 mmol/mol with non-drug treatment

233
Q

How can burned calories be calculated?

A

Time (h) x intensity (MET) x body weight (kg) → kcal

234
Q

Which training intensity significantly reduces HbA1c?

A

HgA1c significantly reduced by training at 75% of VO2max
→ Intensity is more important then duration to lower HgA1c

235
Q

Which VO2max should you aim for in DM treatment?

A

70-80%

236
Q

Which % of 1RM should be aimed for in DM treatment?

A

60-80%

237
Q

How can alcohol reduce blood glucose levels?

A

hypoglycaemic effect

238
Q

How is glucose influenced by training?

A
  • Blood glucose drops during endurance training
  • Blood glucose rises briefly after last sprint
  • Blood glucose increases during strength training and decreases afterwards
239
Q

How long do glucose lowering effects last?

A

up to 48h

240
Q

What is the Fick equation at rest?

A

Oxygen uptake (VO2) = cardiac output x (arterial oxygen content - venous mixed oxygen content)

VO2=(SVHR)(CaO2-CvO2)

241
Q

What is the Fick equation at max effort?

A

VO_2max=(SVmaxHRmax)(CaO_2max-CvO_2max)

242
Q

Which value of the CPET shows as plateau in healthy people?

A

VO2max
→ During maximal effort/exertion
→ Training can increase that plateau

243
Q

Which value is taken if VO2max can’t be reached in patients?

A

Peak VO2 (PVO2) is measured and used as an estimate for VO2max

244
Q

A normal PVO2 is influenced by which factors?

A
  • genetic factors
  • age
  • sex
  • body size
  • quantity of muscles used
245
Q

What is the usual resting VO2 in healthy people?

A

3.5ml/kg/min

246
Q

Which macros are used to generate energy when the RER is 0.7?

A

carbs and fats

247
Q

Which macros are used to generate energy when the RER is 0.8?

A

carbs and proteins

248
Q

What is VE?

A

Minute Ventilation

  • Amount of air that is inhaled and exhaled with one breath
  • Expressed in l/min
249
Q

What is the VAT and when is it usually reached in a CPET?

A

Ventilatory Anaerobic Threshold

  • VO2 at onset of blood lactate accumulation is called lactate threshold or VAT
  • Point at which minute ventilation increases disproportionately relative to VO2
    → Approx at 60-70% of VO2max
250
Q

What happens in the metabolism once the VAT is reached?

A

Afterwards anaerobic metabolism occurs
→ Significant increase of lactic acid in muscles

251
Q

Why do VE and VO2 rise linearly in the first 50-60% of VO2max (eg during CPET)?

A

Reflects aerobically produced CO2 in muscles

252
Q

What is the VT1?

A
  • Called Aerobic Threshold (AE) in sports medicine
  • Called Anaerobic Threshold (AT) by Wasserman
  • Slowly approaching RER of 1
  • Anaerobic threshold starts to contribute a larger portion of energy
    → Increase of CO2 and lactate
  • CO2 and lactate can still be metabolised as long as intensity doesn’t increase
253
Q

What is the VT2?

A
  • Called Anaerobic Threshold in sports medicine
  • Called Respiratory Compensation Point (RCP) by Wasserman
  • Aerobic and additional small amount of anaerobic metabolism don’t supply enough energy anymore
    → Body intensifies anaerobic metabolism
  • Further increase in lactate and CO2 production
  • Body disproportionately increases ventilation to decrease CO2 and work against metabolic acidosis
254
Q

What is the VT3?

A
  • Only in high-performance athletes
  • Not well described yet
  • Also called:
    → Respiratory compensation point
    → Panic breathing
    → Hot ventilation
255
Q

Where can the lactate threshold be found in max exercise test?

A

Located near first break point
→ VT1

LT = Lactate threshold

256
Q

Where can the maximum lactate steady state be found in max exercise test?

A

Located near second break point
→ VT2

MLSS = Maximum lactate steady state

257
Q

What effects does training have on the efficiency of the cardiorespiratory system?

A

→ Decrease in resting heart rate → max HR stays the same

→ Increase in VO2max plateau

→ Increase of resting stroke volume and exercise stroke volume → Heart muscle hypertrophy

→ Increase of arterio-venous O2 difference

258
Q

What equals 1 MET?

A

Normal resting VO2 of 3.5ml/kg/min

259
Q

Which way is electricity traveling through the heart?

A

Electricity traveling through heart is downward diagonal
→ From right shoulder to left abdomen

260
Q

Why does ECG on right arm, shoulder, wrist always show waves pointing downwards?

A

Electrical signal travels away from it -> From upper right to lower left

261
Q

Why does ECG on left middle axillary region always show waves pointing upwards?

A

Electrical signal travels towards it -> From upper right to lower left

262
Q

What time does 1 small box on the ECG paper show?

A

0.04 seconds

263
Q

What time does 1 large box on the ECG paper show?

A

0.2 seconds

264
Q

What time do 5 large boxes on the ECG paper show?

A

1 second

265
Q

10 small boxes on the ECG paper are equivalent to which voltage?

A

1 millivolt

266
Q

Which waves of the Sinus rhythm aren’t always present?

A

Q and S

267
Q

Which part of the electrical stimulation does the p-wave of the sinus rhythm show?

A

Atrial depolarisation

268
Q

Which part of the electrical stimulation does the q-wave of the sinus rhythm show?

A

Depolarisation of septum

269
Q

Which part of the electrical stimulation does the r-wave of the sinus rhythm show?

A

Depolarisation of ventricular walls

270
Q

Which part of the electrical stimulation does the s-wave of the sinus rhythm show?

A

Depolarisation of Purkinje Fibres

271
Q

Why is the r-wave the biggest wave of the sinus rhythm?

A
  • Thick muscle and big contractions are required
  • High voltage is needed
272
Q

Which part of the electrical stimulation does the t-wave of the sinus rhythm show?

A
  • Repolarisation of ventricular walls
  • Smaller voltage than in R-wave
273
Q

Why is the st-segment of the sinus rhythm flat in healthy patients and what does line that isn’t flat indicate?

A
  • No conduction at that time
    → Line is therefore flat
  • Key indicator for myocardial ischaemia or necrosis if line goes up or down
274
Q

How can a decreased pump function of the heart be determined?

A

Determine LVEF (Left ventricle ejection fraction)

275
Q

When is the pump function of the heart decreased?

A

LVEF 20-25% → Only 20-25% of blood volume is effectively pumped into aorta

276
Q

When is the pump function of the heart normal?

A

LVEF >55% → Normal

277
Q

What are the norm values for the interpretation of a CPET?

A
  • VO2peak ≥ 85% of predicted value
  • Anaerobic threshold (VT1) > 40% of predicted VO2max
  • HRpeak > 90% of predicted value OR HRR < 15bpm
  • VEpeak < 85% maximal ventilatory capacity (MVV) or ventilatory reserve > 11l/min
  • Blood pressure < 220/90mmHg

ABNORMAL VALUES INDICATE EXERCISE LIMITATION

278
Q

What are criteria for a maximal effort during the CPET?

A

Client reaches one or more of the criteria below:

→ Predicted VO2peak was achieved and/or plateau in VO2?

→ Predicted Wmax and/or predicted HRmax achieved?

→ VOpeak ≥ 85% of maximal ventilatory capacity (MVV)?

→ BORG score for fatigue 9-10 on a scale of 1-10?

→ Respiratory exchange rate (RER) is > 1.15?

279
Q

What is Gold Stage 1?

A

Mild airway obstruction

FEV1 > 80% of predicted value

FEV1/FVC ratio < 0.7

Approx. 28% of patients in NL

280
Q

What is Gold Stage 2?

A

Moderate airway obstruction

FEV1 50-80% of predicted value

FEV1/FVC ratio < 0.7

Approx. 54% of patients in NL

281
Q

What is Gold Stage 3?

A

Severe airway obstruction

FEV1 30-50% of predicted value

FEV1/FVC ratio < 0.7

Approx. 15% of patients in NL

282
Q

What is Gold Stage 4?

A

Very severe airway obstruction

FEV1 < 30% of predicted value

FEV1/FVC ratio < 0.7

Approx. 3% of patients in NL

283
Q

How can asthma be differentiated from COPD in spirometry?

A

In Asthma FEV1 increases by more than 12% or 200ml after use of bronchodilator

In COPD minimal change of FEV1 after use of bronchodilator

284
Q

What are characteristics of chronic heart failure?

A
  • Inefficiency of the heart
  • Muscle becomes too weak or to stiff to pump blood sufficiently
  • Stiffness often due to high blood pressure
  • Does not refer to the heart stopping
285
Q

What are characteristics of chronic heart disease?

A
  • Several types of pathologies
  • E.g. coronary artery disease
  • Ischaemia and necrosis can happen leading to an infarction/heart attack
286
Q

What are characteristics of an unstable angina pectoris?

A
  • Due to coronary artery disease or atherosclerosis (same as stable angina)
  • Chest pain is sudden and often gets worse over short period of time
287
Q

What are characteristics of a stable angina pectoris?

A
  • Medical term for chest pain
  • Due to chronic heart disease
  • Blockage or narrowing of coronary arteries causes these feelings in the centre of the chest:
    → Pressure
    → Fullness
    → Squeezing
    → Pain
288
Q

What is the FFMI?

A

Fat Free Mass Index

  • indicates how well the muscle development is
  • used instead of BMI in muscular patients or athletes because it’s more accurate
  • body fat percentage is needed for calculation
289
Q

What are norm values for the FFMI?

A

For men:
17-18 weak
19-20 average
21-22 good
23-24 very good
25 upper muscle limit

For women:
13-14 weak
15-16 average
17-18 good
19-20 very good
22 upper muscle limit

290
Q

How is the BMI calculated?

A

bodyweight (kg) : (height (m) x height (m))

291
Q

What is a different term for the FEV1/FVC ratio in spirometry?

A

Tiffeneau-Pinelli Index

292
Q

What does the IPAQ assess?

A

International Physical Activity Questionnaire

Self-reported measurement of duration and intensity of physical activity over the last 7 days

The higher the score the better

293
Q

What are signs of strong exertion /strain upon exertion in chronic heart disease patients?

A
  • angina
  • impaired pump function:
  • shortness of breath disproportionate to exertion
  • fatigue: abnormal fatigue disproportionate to exertion
  • increased peripheral / central edema
  • arrhythmias:
  • high heart rate not in proportion to exertion
  • irregular heartbeat, changes in known arrhythmias
  • abnormal increase or decrease of blood pressure
  • fainting
  • dizziness
  • vegetative reactions (e.g. excessive perspiring, pallor)
294
Q
  • progressive increase in heart failure symptoms;
  • severe ischemia of the cardiac muscle upon exertion;
  • dyspnea while speaking;
  • respiratory frequency of more than 30 breaths per minute;
  • heart rate at rest > 110 bpm;
  • VO2max < 10 mL/kg/min;
  • ventricular tachycardia upon increasing exertion;
  • poorly controlled diabetes mellitus (in consultation with pa-
    tient’s internal medicine specialist); * fever;
  • acute systemic diseases;
  • recent pulmonary embolism (< 3 months ago) causing severe
    hemodynamic strain;
  • thrombophlebitis;
  • acute pericarditis or myocarditis;
  • hemodynamically serious aortic stenosis or mitral valve steno-
    sis;
  • heart valve failure constituting an indication for surgical inter-
    vention;
  • myocardial infarction less than 3 weeks before the start of the
    training;
  • atrial fibrillation with rapid ventricular response at rest (> 100
    bpm);
  • serious cognitive problems (memory, attention and concentra-
    tion);
  • weight gain of > 3 kg within a few days, whether or not ac-
    companied by increased dyspnea at rest.

What do these things indicate?

A

Contraindications for heart failure patients to participate in training programme

295
Q

What is the percentage of ADL impairments elderly due to joint, bone and muscle degeneration?

A

48%!!

296
Q

What do the following criteria indicate?

Patient age > 65
Chronic use of > 5 drugs
Presence of at leat 1 of the following risk factors:
- Impaired renal function
- Impaired cognition
- Increased risk of falling
- Impaired therapy compliance
- Not living independently
- Unplanned hospitalisations

A

Medication assessment (and change) of elderly in collaboration with GP

297
Q

How many people that fall on stairs die?

A

60%

298
Q

What can be said about the presence of atopy (predisposition to allergic reactions) in asthma and COPD?

A

Often present in asthma

Sometimes present in COPD

299
Q

Is there a difference in FEV1 in asthma or COPD concerning daytime?

A

Often decreased in the morning in asthma

No change in COPD

300
Q

What can be said about the presence of nasal symptoms like allergic rhinitis in asthma and COPD?

A

Very often present in asthma

Almost never present in COPD

301
Q

What are norm values for FEV1 in males and females?

A

Males: 3.5L - 4.5L

Females: 2.5L - 3.25L

302
Q

What are pack years?

A
  • Estimates the amount of cigarettes that have been smoked in a lifetime
  • 1 pack is 20 cigarettes (1 joint counts as 4 cigarettes)
  • 1 pack/day for 1 year is 1 pack year
  • 2 packs/day for 1 year are 2 pack years
  • Lung screening should be initiated if patient has 20 pack years or more
303
Q

What are the 5 stages of the mMRC scale for dyspnea?

A

0 - Little - Dyspnea only with strenuous exercise

1 - Mild - Dyspnea when hurrying or walking up a slight hill

2 - Moderate - Walks slower than people of same age because of dyspnea or has to stop for breath when walking at own pace

3 - Many/Strong - Stops for breath after walking just under 100m or after a few minutes

4 - Very much/Severe - Too dyspneic to leave house or breathless when dressing

304
Q

What is a perceived exertion level of “very, very hard” on the Borg scale 6-20?

A

19

305
Q

What is a perceived exertion level of “very hard” on the Borg scale 6-20?

A

17

306
Q

What is a perceived exertion level of “hard” on the Borg scale 6-20?

A

15

307
Q

What is a perceived exertion level of “somewhat hard” on the Borg scale 6-20?

A

13

308
Q

What is a perceived exertion level of “fairly light” on the Borg scale 6-20?

A

11

309
Q

What is a perceived exertion level of “very light” on the Borg scale 6-20?

A

9

310
Q

What is a perceived exertion level of “very, very light” on the Borg scale 6-20?

A

7

311
Q

What is a perceived exertion level of “no exertion at rest” on the RPE 0-10 scale?

A

0

312
Q

What is a perceived exertion level of “very light” on the RPE 0-10 scale?

A

1

313
Q

What is a perceived exertion level of “light” on the RPE 0-10 scale?

A

2-3

314
Q

What is a perceived exertion level of “moderate, somewhat hard” on the RPE 0-10 scale?

A

4-5

315
Q

What is a perceived exertion level of “high, vigorous” on the RPE 0-10 scale?

A

6-7

316
Q

What is a perceived exertion level of “very hard” on the RPE 0-10 scale?

A

8-9

317
Q

What is a perceived exertion level of “maximum effort, highest possible” on the RPE 0-10 scale?

A

10

318
Q

How does blood pressure change/increase?

A

Influenced by the R-A-A System (Renin-Angiotensin-Aldosterone System)
- Lack of oxygen rich plasma in kidneys is interpreted as low BP
→ Kidneys release Renin
- Renin transforms Angiotensinogen into Angiotensin I
- Enzyme ACE (Angiotensin-Converting Enzyme) transforms Angiotensin I into Angiotensin II
- Angiotensin II travels to adrenal glands of kidneys and triggers production of Aldosterone

319
Q

What does angiotensin II cause?

A

Vasoconstriction

320
Q

What does aldosterone cause?

A

vasoconstriction and fluid retention

321
Q

When there is pain at rest in sPAD the ABI is usually?

A

< 0.25

322
Q

What are the 6 steps of patient education in therapy?

A
  1. Being open
  2. Understanding
  3. Wanting
  4. Being able
  5. Doing
  6. Keep doing
323
Q

After supervised exercise therapy of 6 months which walking distance improvement can be expected in sPAD patients?

A

Up to 231%

324
Q
  • age > 70 years
  • productive cough
  • diabetes mellitus
  • smoking
  • COPD: FEV1 < 75%predicted or requiring medication
  • BMI > 27.0 kg/m2
  • Lung function: FEV1 < 80%predicted and FEV1/FVC < 70%predicted

What do these parameters indicate?

A

Increased risk of pulmonary complications in chronic heart disease patients after open heart surgery (according to PPC)

325
Q

1 exploring one’s own physical limits

2 learning to cope with physical limitations

3 optimizing exercise capacity

4 applying diagnostics

5 overcoming fear of physical exertion

6 developing and maintaining a physically active lifestyle

What do these points describe?

A

The goals of physical therapy treatment in chronic heart failure patients

326
Q

practicing skills and activities (to enable the patient to utilize their general or strength endurance in motor activities)

training patient’s aerobic (general) endurance

training local and strength endurance

practicing functions / activities

training to reduce risk factors

What do these points describe?

A

The goals of exercise programme in chronic heart disease patients

327
Q

What is the MDC in the 6MWT for COPD patients?

A

54m (177ft)

328
Q

What does a walking distance below 200m in the 6MWT in COPD patients predict?

A

Predictive of hospitalisation or mortality

329
Q

What is the average walking distance in COPD patients for the 6MWT?

A

380m

330
Q

What are the domains of the EQ-5D-5L?

A

Mobility

Self-care

Usual activities

Pain/discomfort

Anxiety/depression

Health today

331
Q

Which tool can be used to assess self-efficacy?

A

General Self-Efficacy Scale

Self-reported questionnaire with a total score from 10 to 40

The higher the score the better the self-efficacy

332
Q

Which tool can be used to assess patient health and risk factors like depression, eating, alcohol?

A

PHQ

Patient health questionnaire

333
Q

What does the WIQ assess?

A

Walking Impairment Questionnaire

Can be used in sPAD patients

Assesses:
- Walking distance
- Walking speed
- Symptoms during walking

The lower the score the worse the impairment

334
Q

What demmi score is a raw score of 19 points in the de Morton Mobility Index?

A

100 points -> best result

335
Q

What are COPD-related red flags?

A

Desaturation in room air, measured with a saturation meter:
* at SpO2 < 90% at rest (after at least 10 minutes of sitting)
* at SpO2 < 85% during a physical test or exercise therapy

Peripheral oedema

Haemoptysis (coughing up blood)

Excessive sputum production compared to normal

Cyanosis and/or sleepiness during the day in combination with headache

Fever

Tachypnoea at rest

Suspicion of previously unknown co-morbidity

Exacerbation of known co-morbidity

336
Q

When should neuromuscular electrical stimulation training (NMES) not be administered?

A

When patient is able to perform physical training themselves

337
Q

How many sessions should be administered per COPD profile?

A

Profile 1 ➝ 0 sessions (no indication for physiotherapy/exercise therapy C/M)
Profile 2 ➝ at most 6 sessions;
Profile 3 ➝ at most 42 sessions;
Profile 4 ➝ at most 62 sessions;
Profile 5 ➝ at most 70 sessions;
Profile 6 ➝ n/a (secondary or tertiary pulmonary rehabilitation).

338
Q

When does the ejection fraction indicate heart failure?

A

If ≤ 40%

Physiotherapy 2.3 (9 decks)

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