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1
Q

heart failure

effects of beta blockers on HR and BP with rest and exercise

A

HR and BP both decrease with rest and exercise

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2
Q

heart failure

effects of nitrates of HR and BP with rest and exercise

A

rest: increase HR; decrease BP
exercise: increase/no change HR; decrease/no change BP

(Dilates vessels)

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3
Q

heart failure

effects of calcium channel blockers of HR and BP with rest and exercise

CC blockers: end with “dipine”

A

both decrease with rest and exercises

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4
Q

heart failure

effects of digitalis of HR and BP with rest and exercise

A

HR: decrease in pts with aFib and possibly HR
BP: no change with rest and exercise

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5
Q

heart failure

effects of diuretics of HR and BP with rest and exercise

A

HR: no change with rest and exercise
BP: no change or decrease with rest and exercise

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6
Q

heart failure

effects of vasodilators of HR and BP with rest and exercise

A

HR: increase/stay the same with R and E
BP: decrease with R and E

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7
Q

heart failure

effects of ACE inhibitors, Angiotensin II Blockers, and Alpha Adrenergic Blockers of HR and BP with rest and exercise

A

HR: no change with R and E
BP: decrease with R and E

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8
Q

heart failure

effects of nicotine of HR and BP with rest and exercise

A

HR: increase/stay the same with R and E
BP: increase with R and E

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9
Q

heart failure

left sided heart failure

A
  • pathology of the LV reduces cardiac outpu leading to a backup of fluid into the LA and lungs.
  • the increased fluid in the lungs produces 2 hallmark pulmonary signs of left sided HF:SOB and cough
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10
Q

right sided heart failure

A
  • occurs from direct insult to the RV caused by conditions that increase PA pressure.
  • increased oressure within the PA subsequently increases afterload, thereby placing greater demands on the RV and causing it to go into failure
  • blood is not effectively ejected from the RV and backs up into the RA and venous vasculature, producing 2 hallmark peripheral signs: jugular venous distention and peripheral edema
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11
Q

ejection fraction norm range

A

EF: 55-75%

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12
Q

terminology difference of compensated vs decompensated HF

A

compensated: the pt’s congestive symptos can be relieved by medical intervention

decompensated: shows s/s of congestion and requires medical and pharmacological readjustment

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13
Q

common s/s of CHF

A

fatigue
dyspnea
edema (pulmonary and peripheral)
weight gain
presence of S3 heart sound
renal dysfunction

other symptoms:
- paroxysmal nocturnal dyspnea
- orthopnea
- bendopnea

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14
Q

describe S3 heart sound

A

low frequency heart sound heart in early diastoleand occrs due to poor ventricular compliance and sibsequent turbulence of blood within the ventricle
- correlated with increase left ventricular end diastolic pressures and pulmonary capillary wedge pressure

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15
Q

paroxysmal nocturnal dyspnea vs orthopnea vs bendopnea

A
  • paroxysmal nocturnal dyspnea: sudden episodes of SOB occuring in the night
  • orthopnea: increased SOB in the recument position
  • bendopnea: presence of SOB when the pt bends fwd
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16
Q

NYHA heart failure classifications

A
  • class 1: pts with cardiac disease but without resulting limitations of physical activity. ordinary physical activity does not cause undue fatigue, palpitation, dyspnea or anginal pain
  • class 2: pts with cardiac disease resulting in slight limitation of physical activty. they are comfortable at rest. ordinary physical activity results in fatigue, palpitations, dyspnea, and aginal pain
  • class 3: pts with cardiac disease resulting in marked limitations of physicalactivity. they are comfortable at rest. less than ordinary physical activity causes fatigue, palpitations, dyspnea or anginal pain
  • class 4: pts with cardiac disease resulting in inablity to carry on any physical activity without discomfort. symptoms of cardian insuffiencey or of the anginal syndrome may be present even at rest. if any physical activity is undertaken, discomfort is increased
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17
Q

dyspnea scale

A

0- no dyspnea
1- mild, noticeable
2 - mild, some difficulty
3 - mod difficulty but can continue
4 - severe difficulty, cannot continue

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18
Q

angina scale

A

0 - no angina
1 - light, barely noticeable
2 - moderate, bothersome
3 - severe, very uncomfortable: preinfarction pain
4 - most pain ever experienced; infarction pain

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19
Q

hypoxemia vs hypercapnea

A

hypoxemia- decreased amount of oxygen in the aterial blood to the tissue
hypercapnea - increased amount of co2 within the arterial blood will develop

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20
Q

cor pulmonale

A

increased pulmonary vascular resistance 2/2 capillary wall damage and reflex vasoconstriction in the presence of hypoxemia results in pulmonary HTN and RV hypertrophy

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21
Q

most common type of restrictive lung disease

A

pulmonary fibrosis
AKA
usual interstitial pneumonia

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22
Q

classic signs and symptoms of interstitial lung disease

A

symptoms: dyspnea w activity and persistant non productive vough

signs: rapid shallow breathing, limited chest expansion, inspiratory crackles, especially over the lower lung fields, digital clubbing and cyanosis

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23
Q

clincal significane for a 6MWT

A

25-35 meters

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24
Q

clinical significance for gait speed

A

0.05m/sec

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25
Q

common congenital disease of lymphedema

A

milroys disease

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26
Q

pitting edema

A

pressure on the edematous tissues with the fingertips causes an indentation of the skin that persists for several seconds after the pressure is removed.
this reflects significant but short duration edema with little or no fibrotic changes in the skin or subcutanous tissue

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27
Q

brawny edema

A

pressure on the edematous areas feels hard with palpation. this reflects a more severe form of interstitial swelling with progressive, fibrotic changes in subcutaneous tissues

brawny as in the paper towel guy - hes hard/tough

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28
Q

weeping edema

A

represents the most severe and long duration form of lymphedema. fluid leaks from cuts or sores; would healing is significantly impaired. exclusively in the LE

rare

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29
Q

stemmer sign

A

positive - indication of late stage 2 or stage 3 lymphedema
- indicitive of worsening condition

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30
Q

stage 1 pressure injury

A

non blanchable erythema of intact skin
- intact skin w/ a localised area of non blanchable erythema which may appear differently in darkly pigmented skin
- presence of blanchable erythema or changes in sensation, temperature, or firmess may precede visual change.
- colors do not include purple or maroon - this may indicate deep tissue pressure

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31
Q

stage 2 pressure injury

A

partial thickness skin loss with exposed dermis
- partial thickness loss of skin with exposed dermis
- the wound bed is viable, pink, or red, moist and may also present as an intact or ruptured serum filled blister
- granulation, slough and eschar are NOT present

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32
Q

stage 4 pressure injury

A

full thickness skin and tissue loss
- with exposed or directly palpable fascia, mm, tendon, ligament, cartilage, or bone in the ulcer.

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32
Q

unstageable pressure injury

A

obscured full thickness skin and tissue loss
- obsucred by slough or eschar

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32
Q

stage 3 pressure injury

A

full thickness skin loss
- adipose tissue is visible in the ulcer and granulation tissue and epibole are often present
- slough and eschare may be present
- undermining may occur
- fascia, mm, tendon, ligament and cartilage, bone are not exposed

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32
Q

ASIA A

A

complete
- no motor or sensory function presered in the sacral segments S4-S5

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33
Q

ASIA B

A

sensory incomplete
- sensory but not motor function is preserved below the neurological level and includes the sacral segment S4-S5
- no motor function is preserved more than 3 levels below the motor level on either side

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33
Q

ASIA C

A

motor incomplete
- motor fx is preserved at the most caudal sacral segments for voluntary anal contraction OR the patient meets the criteria for sensory incomplete status and has some sparing of motor function more than 3 levels below the ispsilateral motor level on either side of the body
- less than half of key mm functions below have a >=3

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33
Q

ASIA D

A

motor incomplete
- motor fx is preserved at the most caudal sacral segments for voluntary anal contraction OR the patient meets the criteria for sensory incomplete status and has some sparing of motor function more than 3 levels below the ispsilateral motor level on either side of the body
- **more than half of key mm functions below have a >=3 **

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33
Q

brown sequard syndrome

A

stab or gunshot wound
ipsilateral side:
- sensory loss (proprioception, light touch, vibratory) due to DCML tract paralysis
- paralysis due to the CST (lateral) tract
contralateral side
- loss of sense of pain and temp due to STT tract damage
- the loss begins several dermatome segments below the level of injury

can achieve good functional gains during inpatient rehab

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33
Q

anterior cord syndrome

A

related to flexion injuries to the c/s
- loss of motor function (CST) below the level of injury
- loss of sense of pain and temp (STT) below the level of injury

  • DCML is preserved (priorprioception, light touch, vibratory)

longer length of inpatient rehab

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34
Q

central cord syndrome

A

most common syndrome
- occurs from hyperextension in the c/s or congenital/degenerative
- UE > LE
- motor > sensory
- normal sexual, b/b are retained

typically recover ambulation

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35
Q

cauda equina injuries

A

areflexic b/b and saddle anesthesia
considered peripheral nerve injuries (LMN)

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36
Q

conus medullaris syndrome

A

mixture of LMN and UMN
occurs very distal portion of spinal cord gets damaged

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37
Q

symptoms of autonomic dysreflexia

A

HTN
bradycardia
HA
profuse sweating
increased spasticity
vasodilation (flushing) above the level of lesion
constricted pupils
nasal congestion
piloerection (goosbumps)
blurred vision

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38
Q

normal BP for a person with an SCI

A

above T6 level
systolic: 90-110 mmHg

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39
Q

what level of SCI can drive with adaptive controls

A

C6

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40
Q

differences between fibromyalgia and myofascial pain syndrome

A

fibro
- tender points at specific sites
- no referred patterns of pain
- no tight bands of mm
- fatigue and waking unrefreshed

myofascial pain
- trigger points in mm
- referred patterns of pain
- tight band of mm
- no related fatigue complaints

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41
Q

characteristics of fibromyalgia

A
  • first symptoms can occur at any age but usually appear during early to middle adulthood
  • pain is reported in the scapula, head, neck chest and low back
  • fluctuations of symptoms
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42
Q

Most common characteristics of an ACA

A

Contra lateral hemiparesis
Sensory LE>UE

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43
Q

Most common characteristics of a MCA

A

Contra lateral spastic hemiparesis
Sensory loss in the face and UE>LE

44
Q

Most common occlusion in a stroke

A

Middle cerebral artery

45
Q

cellulitis

A

connective tissue skin infection
- poorly defined and widespread
- can be contagious
- skin is red/hot/ edematous

46
Q

shingles

A

cn 3 involvement; eye pain; corneal damage; loss of vision with cn 5 involvment

47
Q

epidermal burn

A

erythematous pink or red; irritated dermis

  • no blisters, dry surface; delayed pain, tender
48
Q

superficial partial thickness burn

A
  • bright pink or red, mottled red; inflammed dermis; erythematous WITH BLANCHING AND BRISK CAPILLARY REFILL
  • intact blisters, moist weeping or glistening surface when blisters are removed; very painful
  • sensitive changes in temperature, exposure to air currents, light tough
  • mod edema; spontanous healing
49
Q

deep partial thickness

A
  • mixed red, waxy white; blanching WITH SLOW CAPILLARY REFILL
  • broken blisters, wet surface; sensitive to pressure by insensitive to ligh touch touch or soft pin prick
50
Q

full thickness burn

A
  • white ischmic, charred, tan, fawn, mahogany, black, red; NO BLANCHING, poor distal circulation
  • ## parchment like, leathery, rigid, dry, body hair easily pulled out
51
Q

subdermal burn

A
  • charre
  • subcutaneous tissue evident, mm damage, nuerological involvement
52
Q

the deeper the injury, the ___it will appear

A

the deeper the injury, the whiter the sking will appear

53
Q

autolytic debridement

A

natural debridement promoted under occlusice or semiocclusive moisture-retentive dressings that result ins in solubilizations

contraindications:
- infected wounds
- woulds of immunospressedd ind.
- dry gangrene or dry ischemic wounds

selective debridement

54
Q

enymatic debridement

A

chemical debridement that promots liquefication of necrotic tissue by applying topical prepartion of collagenolytic enzymes to those tissues

indications:
- all moist necrotic wounds
- eschar after cross-hatching
- homebound ind.
- people who cannot toleratte surgical debridment

contraindications:
- ischemic wounds unless adequate vascular status has been determined
- dry gangrene
- clean, granuluated wounds

selective debridement

55
Q

mechanical debridment

A

removes foreign material to devitalized or contaminated tossue by physical forces (wet-dry dressing, pulsatile lavage) but also may remove healthy tissue

indications:
- wounds with moist nectrotic tossue or forerign material present

contraindications:
- clean, granulated wounds

non-selective debridement

56
Q

sharp debridment

A

indications:
- scoring and/or excision of leathery eschar
- excision of moist necrotic tissue

contraindications:
- cellulitis with sesis
- when infections threathens the ind.’s life
- ind on anticoagulant therapy

selective debridement

57
Q

transparent fils

A

indications:
- stage 1-2 pressure ulcers
- autolytic debridement

advantages:
- impermeable to external fluids and bacteria
- promotes autolytic debridmnet
- min friction

disadvanatges:
- not to be used with fragile surrounding skin or infected wounds

58
Q

hyrdocolloids

A

form gelatinous mass over the wound bed; available in paste f orm that can be used as a filler for shallow cavaity wounds

indications:
- protection of partial thickness wounds
- autolytic debdiement of necrosis or slough
- wounds with mild exudate

advantages:
- maintains moist enviroment
- nonadhessive to healing tissue

containdications:
- non transparent
- may soften or change shape with heat or friction
- not recommended for wounds with heavy exudate, sinus tractm or infections; wounds that expose bone or tendon
- dressing edges may occur

considerations:
- allow 1-1.5in margin of healthy tissue around the edges

think pimple patch style

59
Q

hyrdogels

A

indications:
- partial and full thickness wounds
- wounds with necrosis or slough
- burns and tissue damaged by radiation

advantages:
- soothing and cooling
- fill dead space
- rehydrate wounds
- conform to wound bed

containdications:
- require secondary dressing
- not used for heavy exudating wounds
- may dry out and then adhere to the wound bed
- may macerate the skin

considerations:
- dressing changes 8-48 hours

60
Q

foams

A

semipermeable membranes

indications:
- partial and full thickness wounds with minimal to moderate exudate
- secondary dressing for wounds with oacking to provide additional absorption
- provide protection and insulation

advantages:
- insulate wounds
- provide some padding
- manage min to heavy exudate

containdications:
- non transperant
- require secondary dressing
- poor conformability to deep wounds
- not for use with dry eschar or wounds with no exudate

61
Q

alginates

A

soft, absorbent, nonwoven dressings derived from seeweed

indications:
- wounds with moderate to large amounts of exudate
- wounds with combination of exudate and necrosis
- wounds that require packing and absorption
- infected and noninfected excuding

advantages:
- absorb 20x their weight in drainage
- fill dead space

containdications:
- require secondary dressing
- not recommended for dry or lightly exciding wounds
- can dry wound bed

62
Q

gauze dressing

A

indications:
- wounds with dead space, tunneling, or sinus tract
- wounds wiht combination excudate or nerotic tissue

advantages:
- readily available
- cost effective
- can be used on in infected wounds

containdications:
- delayed healing if used impromperly
- pain on removal

considerations:
- if too wet, dressings will macerate surrounding skin

63
Q

herpes zoster

A

CN 3 and 5 affected
you can provide TENS
no heat

presents mostly unilateral
raised palpation <2mm
pink with silvery white appearance

63
Q

blisters:
vesicles:
wheals:
pustules:

A

blisters: sac with fluid
vesicles: fluid filled, domed shaped, >=0.5cm
wheals: hives
pustules: pus filled

64
Q

dressings from mild exudate to heavy exudate

A
65
Q

selective vs nonselective examples

A

selective:
- sharp
- enzymatic
- autolytics

nonselective:
- wet to dry
- wound irrigation
- hydrotherapy

66
Q

when do you chose selective vs nonselective

A

at least 50% = selective

67
Q

thermal modalities effects

A
68
Q

cyrotherapy application effects

A
69
Q

hot pack settings

A
  • temp: 160-170 deg
  • time: 20-30min
  • 6-8 layers
  • peaks at 5 min
70
Q

cold pack settings

A
  • stored at 25 deg
  • time: 10-20min
  • can be applied every 1-2 hrs
  • stages of cold: cold-burning-aching-numb

we want numb and so these are normal reactions

71
Q

containdications for thermotherapy and cyrotherapy

A
72
Q

parameters for e-stim

A

pulse frequency: quick/higher=comfortable

pulse duration: more uncomfortable the longer they are (larger mm need it to be longer to reach desired mm)

ratio: 1:5

ramp: at least 2 seconds

73
Q

high voltage pulsed galvanic current

wound care

A

negative - infected
positive - healing

pulse frequency regardless: 60-125 pps
pulse duration: 40-100

wound care

74
Q

iontophoreses meds
(neg/pos)

A

“ISAD”

75
Q

types of TENS

A
76
Q

ultrasound characteristics

A
77
Q

ultrasound decision making tree

A
78
Q

when do you place the pt in supine when applying lumbar distraction

A

interverterbral joints, facet joints, mm elongation

79
Q

when do you place the pt in prone when applying lumbar traction

A

posterior disc herniation

80
Q

you want to apply lumbar traction on L5-S1 intervertebral space, how much hip flexion do you need

A

45-60deg

81
Q

you want to apply lumbar traction on L3-4 intervertebral space, how much hip flexion do you need

A

75-90deg

82
Q

you apply 25% of bodyweight during lumbar traction - what area are you working on?

A

disc protrusions, spasms, elongation

83
Q

you apply 50% of bodyweight during lumbar traction - what area are you working on?

A

joint distraction

84
Q

you initially want to get your pt set up on cervical traction, how many pounds do you start with

A

7-9lbs

85
Q

you apply 11-15lbs of bodyweight during cervical traction - what area are you working on?

A

disc protrusion, spasms, elongation

86
Q

```

~~~

you apply 20-29lbs of bodyweight during cervical traction - what area are you working on?

A

joint distraction

or 7% bodyweight

87
Q

difference of when to place the electrodes close vs far

A

close = mm relaxation
far = mm re-ed

88
Q

early heel off =
early toe off =

A

early heel off = tight PFers
early toe off = tight hip flexors

89
Q

what does a backwards trunk lean in swing mean

A
90
Q

what happens to COM when theres an amputation to the UE and/or LE

A

UE= COM lowers
LE= COM is higher

91
Q

amputations

low walls =
high walls =

A

low walls = weak mm
high walls = tight mm

92
Q

elevated triglycerides

A

150 mg/dl or higher

93
Q

low HDL

A

men: less than 40
women: less than 50

94
Q

example of hypothyroidism

A

hashimotos disease

95
Q

symptoms of hypothyroidism

A
  • weight gain
  • mental and physical lethargy
  • dry skin and hair
  • low blood pressure
  • constipation
  • intolerance to cold
  • goiter
96
Q

example of hyperthyroidism

A

graves disease

97
Q

symptoms of hyperthyroidism

A
  • nervousness
  • hyperreflexia
  • tremor
  • hunger
  • weight loss
  • heat intolerance
  • palpitations
  • tachycardia
  • goiter
  • diarrhea
98
Q

s/s for addisons disease

A
  • increased bronze pigmentation of skin
  • weakness, decreased endurance
  • anorexia, dehydration, weight loss, GI disturbances
  • anxiety, depression
  • decreased tolerance to cold
  • intolerance to stress
99
Q

difference between addisons disease and cushing’s syndrome

A

addisons: decrease production of cortisol and aldosterone
cushings: excessive production pf cortisol

100
Q

s/s for cushings syndrome

A
  • decreased glucose tolerance
  • round “moon” face
  • obesity
  • decreased testosterone/mentstrual periods
  • muscular atrophy
  • edema
  • hypokalemia
  • emotional changes
101
Q

how hot should the pool be for rehab exercises

A

91-93 F
(33-34 C)

102
Q

difference between OA and RA

A
103
Q

contraindications vs precautions for pool therapy

A
104
Q

referral patterns
- liver
- gall bladder
- stomach
- heart
- pancreas

A
105
Q

appendicitis

A

pain is abrupt at onset, localized to the epigastric or periumbilical area; intensity increases over time

  • rebound tenderness (Blumberg’s sign) is present in the response to depression if the abdominal wall at the site distance from the painful area
  • point tenderness is located at McBurnerys point (1.5-2in above ASIS) in R LQ
  • rovsing’s sign elicits pain in the RLQ
  • obtruator sign: RLQ pain with IR and flexion to 90 deg of the R hip with 90deg of knee flex
  • markle’s sign: pain elicited in the RLQ when a patient drops from standing on toes to the heels with a jarring landing
  • psoas sign: pain in the RLQ occurs w hip ext from inflammation of the peritoneum overlaying the psoas mm
106
Q

stages of cancer

A

stage 0: carcinoma in situ
stage 1: tumor is localized, equal to or less than 2 cm; has not spread to lymph nodes
stage 2: tumor is advancedl 2-5cm with or without lymph node involvement
stage 3: tumor is locally more advanced; spread to lymph nodes; cancer is designated stage 3 or 4 depending upon specific type of cancer
stage 4: the tumor has metestasized or spread to the other ograns throughout the body

107
Q

contraindications for exercising with an ind with cancer

A
108
Q

lab values/ranges

platelet count

A

normal: 150k - 450k
some limitations: 50k-150k
mod exercise: 30k-50k
light exercise: 20k-30k
ROM, ADLs, walking with physcian approval: <20k

109
Q

lab values/ranges

CPC: white blood count

A

normal: 4800-10,800

light exercise: >5000
no exercise: <5000 with fever
no exerise + protective mask required: < 1000

110
Q

lab values/ranges

hemoglobin

A

women: 12-16
men: 13-18

regular exercise: >10
light exercise: <8-10
no exercise: <8

111
Q

lab values/ranges

hematocrit

A

women: 37-48%
men: 45-52%

light or regular exercise: > 25%
no exercise: <25%

112
Q

posterior leaf spring

A

aids with PF
“springs fwd” to lift foot off floor

prevents foot drop

needs little to minimal sagittal plane restriction

113
Q

hinged AFO

A

limits sagittal plane mvmts, facilitating progression to foot flate position in early stance

114
Q

ground reaction orthosis

A

to allow for control at both ankle and knee. prevents the knee from collapsing into flexion during the stance phase by restricting DF at the ankle.

used for pts who have: knee bucking during stance phase or present with a crouched gait

in order for the GRAFO to be effective, the pt should have at least 3/5 mmt of the quads

115
Q
A

Final Frontier (20 decks)

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