RHEUMATIC CONDITIONS Flashcards
What sensations are affected in the sensory assessment of a pt with Systemic Lupus Erythematosus?
Light touch, vibration and proprioception
What sensations are affected in the sensory assessment of a pt with Diabetes Mellitus?
Light touch, pain and proprioception
What rheumatic condition causes a decrease in chest expansion due to a possible fibrosis affectation of the lungs?
Scleroderma
What rheumatic condition causes heliotrope rash and gottron papules?
Dermatomyositis
What rheumatic condition is urine analysis lab test useful for?
Systemic Lupus Erythematosus
True or False. Decreased distal limb reflexes is seen in SLE and DM.
True
What is the triad of Reactive Arthritis or Reiter’s syndrome?
Conjunctivitis, Urethritis, Arthritis
What rheumatic condition is a contraindication for cryotherapy?
Scleroderma
What is first class medication for neuropathic pain?
Tricyclic antidepressants
When is carb intake done for an exercise?
Carb intake before an exercise is needed
How many hours should an exercise be done after insulin administration to avoid enhancing insulin circulation?
1 hour
What could occur during exercise up to 24 hours after exercise when carb intake is not done on a diabetic pt.? (hyperglycemia/ hypoglycemia)?
Hypoglycemia
Appropriate or Inappropriate. Do not schedule an exercise at peak of insulin.
Appropriate
What is the normal range of blood glucose levels (FBS Test)?
<100 mg/dL
Give the parameters for Conventional (high-rate) TENS.
___ pps, ___ us, sensation to be felt: ____, ___ mins, rationale: ____
Conventional TENS: 100-150pps, 50-80us, to produce tingling, 20 mins, to reduce pain
What modality is Psoriatic Arthritis a contraindication of?
Ultrasound: contraindicated on areas with Psoriatic Arthritis as it can increase risk of infection
True or False. Pt’s with arthritic conditions have increased risk of falls
True
What gait pattern should be used for a pt. with a neuropathic ulcer on the forefoot?
3 point gait pattern
What gait pattern should be used for a pt. with a neuropathic ulcer on the heel?
3-1 point gait pattern/ Modified 3 point gait pattern
What is the blood glucose level for a pt. to be diagnosed with Diabetes (FBS Test)?
> 126 mg/dL
True or False. The higher the ABI value the more severe arterial disease.
False. The lower the ABI value the more severe arterial disease.
What is the N value of ABI?
1.19-0.95
What type of wound closure is when the wound is left open to heal on its own?
Secondary Intention
What type of wound closure is when the wound is allowed to heal by secondary intention and then is closed by primary intention as the final treatment?
Tertiary Intention
What arterial disease is seen in young men who smoke?
Thromboangitis Obliterans (Buerger’s disease)
What is the vasomotor disease of small arteries and arterioles?
Raynaud’s Disease
What arterial disease is a peripheral manifestation of atherosclerosis?
Arteriosclerosis Obliterans (ASO)
True or False. Edema is seen in both arterial and venous insufficiency.
False. Edema is seen only in VENOUS insufficiency
Venous insufficiency or arterial insufficiency. What has decreased pulses, pallor on leg elevation, and rubor when dependent?
Arterial insufficiency
Upon performance of trendelenburg test, the distention of the veins within 5 secs after the tourniquet was removed indicates what?
Incompetence of superficial veins
What type of wound closure is usually done on infected wounds?
Tertiary intention
Which electrode is ideal for infected wounds (+) or (-) ?
Negative (-)
What do you call a color green wound drainage?
Infected pus
How many seconds indicates arterial insufficiency when performing venous filling test?
20 seconds of filling time
An ABI result of 0.63 may be indicative of ?
Moderate arterial disease
How long can the superficial dermis tolerate ischemia before breakdown occurs?
2-8 hours
How long can the deeper muscle, connective and fat tissues tolerate ischemia before breakdown occurs?
2 hours or less
True or False. Body temperature and humidity can cause pressure ulcer
True
What is the first clinical sign of pressure injury?
Blanchable erythema with increased skin temperature
In performing Buerger’s Test how long will the pt’s leg be elevated to 45 deg?
3 mins
What makes the Homan’s test (+) and what does it indicate?
(+) Pain in the calf indicates DVT
What NPUAP stage is granulation tissue and epibole often present?
Stage 3 Pressure Injury: Full-thickness skin loss
Appropriate or Inappropriate. Whirlpool indicated for clean wounds
Inappropriate.
What ulcer is contraindicated for Whirlpool?
Venous ulcers
What intervention is used to speed healing by rapid removal of contaminants?
Pulsatile lavage with suction
True or False. Ordinary bath soaps are useful to promote wound healing
False. It is very cytotoxic to the cells
What type of debridement is more effective for small areas of necrosis?
Enzymatic debrdement
What two interventions are both non-selective debridement and cleansing?
Whirlpool and Pulsatile lavage with suction
How many days are the newly hatched larvae placed on the wound before removal?
2-5 days before removal
In autolytic debridement, how long should moisture retentive dressings be held in contact with the wound bed?
3-7 days
What is a contraindication to antiseptics agents?
Non-infected wounds
What is the purpose of oxydizing agents like hydrogen peroxide solution?
Removal of loose debris
What 2 topic agents are used to treat thermal wounds like burns?
Silvadene/ Silver sulfadiazine
Sulfamylon/ mafenide acetate
What antibacterial agent is used for Staphylococcus A.?
Bactroban/ mupirocin ointment
What are the 4 different types of topical agents>
Antiseptics, antibacterials, analgesics and growth factors
What term refers to promotes tissue healing primarily by ionic effects, attracting or repelling charged entities?
Galvanotaxis
What do you call the use of an electrical current to promote transdermal drug penetration?
Iontophoresis
Give the parameters for ES for tissue healing (Inflammatory phase/infected).
Waveform: ___, Polarity: ___, ___ pps, ___us, Sensation to be felt: ___, Treatment time: ___
Waveform: HVPC, Polarity: Negative, 60-125 pps, 40-100us, Sensation to be felt: to produce comfortable tingling, Treatment time: 45-60 mins
How long is PSWD usually applied for?
30-60 mins, 1x or 2x/daily
What is the shortest wavelength used in the therapy?
UVC
How many inches away is the lamp from the area of the decubitus ulcer?
2 ~ 4 in. away from the area of the decubitus ulcer
What rheumatic condition is contraindicated to the use of UVR?
Systemic Lupus Erythematosus (SLE)
What orthosis is the gold standard of care for neuropathic ulcers?
Total contact casting (TCC)
What ABI value is a contraindication to TCC?
ABI <0.45
What orthosis is as effective as TCC for wounds at toes or metatarsal heads?
DH walker
What orthosis is good for forefoot ulcers?
Forefoot relief shoe (forefoot is hanging in space)
What orthosis is effective in healing digital plant ulcers?
Healing shoe
Give the parameters for Thermal US on superficial tissues.
100% duty cycle x 3MHz x 0.5-1.0W/cm2 x 5 mins c mild comfortable warmth to promote tissue extensibility
What shoe wear is used to remove pressure off the metatarsal head?
Rocker bottom
What type of lymphedema is caused by dissection of the lymphatic system?
Secondary lymphedema
During this phase of wound healing, epithelial cells migrate beneath the scab to bridge the wound.
Migratory phase
True or False. The zone of coagulation is the area of necrosis
True
True or False. Apocrine sweat glands start to persist at birth.
False. Apocrine sweat glands start to persist at puberty.
This epidermal layers marks the transition between the deeper, metabolically active strata and the dead cells of the more superficial strata
Stratum granulosum
What intervention mistakes may lead to heterotrophic ossification?
Overstretching
What i the timeframe for maturation phase of wound healing?
Day 9 to 2 years after hte injury
True or False. A limited cutaneous type of scleroderma usually presents with a long hx of Raynaud’s disease.
True
A pt diagnosed with Rheumatic conditions presents with joint pain and inflammation on B wrists, hands and knees. What is the most appropriate AD to reduce joint loading?
Platform crutch
True or False. The ideal healing time for neuropathic ulcer is 12-20 wks.
True
Good prognosticating factors include a duration of __months and wound area of __sq. cm
Duration of <2 months and Wound area of <2 sq. cm
The means of transmission for pt’s with Leprosy is through ____.
Droplet
What is the most common cause of burn injury in the pediatric age?
Scald burn
True or False. Pencil in cup deformity is associated with PsA
True
This type of dermatitis affects skin that gets wet frequently and presents as small, itchy humps on the sides of the fingers or toes and progresses to a rash.
Dyshidrotic
True or False. SLE in pt’s over 40 tend to have a more active disease course.
False. SLE is more active in pt’s <40 and during first years after dx
True or False. The erythema migrans associated with Lyme Disease may have delayed onset of 7 days after bite from an infected tick.
True
Is Reactive Arthritis have a clinical presentation of asymmetrical or symmetrical arthritis?
Asymmetrical arthritis begins in knee and ankle
What modality is contraindicated for Progressive systemic sclerosis?
Cryotherapy
True or False. PsA combined features of RA and Spondyloarthropathy.
True
What medications have shown to reduce radiographic progression among pt’s with PsA?
TNF inhibitor
True or False. If healing of wound occurs between 14 and 21 days, compression is strongly recommended.
True
What joint is commonly affected in arthritis associate with Lyme disease?
Knee
True or False. At least 5 points in CASPAr criteria to confirm Psoriatic Arthritis.
False. At least 3 points to confirm PsA
In the early phase of burn, what type of ROM is preferred?
AROM
What type of stretch is considered the safest and yield most changes in soft tissue an scar?
Low-load, long-duration stretch
Skin grafting and compression is mandatory in burn pt’s with healing time of __days.
Healing time is longer > 21 days
Under what phase of burn care is wound debridement/wound care?
Wound Excision Phase
What is the most commonly used topical agent for burn and is also effective against pseudomonas infections?
Silver Sulfadiazine
What is the common positional deformity of the ankle?
Ankle Plantarflexion
What depth of burn has broken blisters?
Deep-partial thickness burn
What is the proper sequence of doffing of protective garment?
Gown > Gloves > Mask > Cap (Remember gown first then distal to proximal)
What is the proper sequence of donning of protective garment?
Cap > Mask > Gown > Gloves (Remember proximal to distal)
