Sectional 2 (part One) Flashcards
_ is a serious long term disease of the airways that lead to your lungs, it makes everything the sides of the air was in your lungs inflamed and swollen, making it difficult to breathe.
ASTHMA
What are the 4 most common signs associated with asthma?
SW CT
- shortness of breath
- wheezing
- coughing
- tightness in the chest
What are the 4 S’s of Asthma?
Sensitivity
Swelling
Secretions
Spasms
Goal in PT is not to screen for asthma but to be?
To be prepared if you patient has an asthmatic attack/ episode in the clinic
With _ _ _, most individuals with asthma will have symptoms.
With STRENUOUS PHYSICAL EXERCISE most individuals with asthma will have symptoms
Exercise induced asthma can occur - _ post exercise onset. Should use _ _ exercises, and have an awareness of the individual patient’ _ _ _, as _ _ between individuals.
Exercise induced asthma can occur 5-10 MINUTES post exercise onset
Should use BRONCHODILATORS BEFORE exercise, and have an awareness of the individual patients TYPICAL ASTHMA ATTACK , as SYMPTOMS VARY between individuals.
Asthma is often worse _ _, due to _ _ in bronchomotor tone and reactivity.
Is often worse AT NIGHT, due to CIRCADIAN VARIATIONS in bronchomotor tone and reactivity.
Proper - and - may prevent of reduce the incidence of exercise induced asthma (EIA)
Proper WARM-UP AND COOL-DOWN may prevent or reduce . . .
Sports that require _ _ or are _, _ _ activities are more likely to trigger EIA
Sports that require CONTINUOUS ACTIVITY or are COLD, DRY WEATHER activities are more likely to trigger a EIA
Sports such as swimming, walking, leisure biking, hiking, downhill skiing or team sports that require short bursts of energy (baseball, football, wrestling, golfing, gymnastics) are _ _ to trigger an EIA
. . . Are LESS LIKELY to trigger an EIA
Sports such as soccer, basketball, field hockey, long distance running, cross country skiing, hockey and cycling/ mountain biking are _ _ to trigger EIA
. . . Are MORE LIKELY to trigger EIA
Short acting beta agonist inhalers usage guidelines: should take - puffs, _ to _ _ before exercise to prevent symptoms for _ to _ _.
Should take 2-4 puffs
5 TO 30 MINUTES before exercise
Prevents symptoms for 2 TO 3 HOURS
Cromolyn Sodium or nedocromil sodium inhaler usage guidelines: should take _ to _ _ before exercising, should be taken _ to _ _ before exercising to prevent symptoms for _ to _ _.
Should take 2 TO 4 PUFFS before exercising
Should be taken 5 TO 30 MINUTES before exercising
To prevent symptoms for 1 TO 2 HOURS
With both short acting beta agonist and cromolyn sodium inhalers it is best if _ _ _ exercising
It is best if TAKEN JUST BEFORE exercising
Long acting beta agonist inhalers usage guidelines: Should take _ _ for MDL, and _ _ for DPI; should be taken _ _ _ _ before exercise; prevents symptoms for _ to _ _ with intermittent use and with continuous use, the protective effect will last _ than _ _ .
Should take 2 PUFFS for MDL, and 1 PUFF for DPI
Should be taken AT LEAST 30 MINUTES before exercise
Prevents symptoms for 10 TO 12 HOURS with intermittent use and with continuous use, the protective effect will last LESS THAN 8 HOURS
Leukotriene modifiers usage guidelines: should be taken _ _ _ _ prior to exercise, can prevent symptoms for _ _ _ _ depending upon medication.
Should be taken AT LEAST 120 MINUTES prior to exercise
Can prevent symptoms for UP TO 24 HOURS depending upon medication
COPD and emphysema patients should not be put in _ or _ position (_ position is better) during PT treatment. Therefore bridging exercises would be _. Also need to make sure that if they are exercising in a pool that they _ _ _ than _ _.
COPD and emphysema patients should not be put in SUPINE OR TRENDELENBERG position (FOWLER/ LONG SIT position is better) during PT treatment
Therefore bridging exercises would be CONTRAINDICATED
Also need to make sure that if they are exercising in a pool that they DON’T GO DEEPER than WAIST HEIGHT
When exercising a COPD/ emphysema patient on a treadmill the speed should be kept to _ _ _ mph.
Should be kept to LESS THAN 3.5 mph
_ _ is a chronic inflammatory autoimmune disease that effects the CNS. It effects the Neurons of the brain and spinal cord including the myelin sheath.
MULTIPLE SCLEROSIS is a chronic inflammatory autoimmune disease . . . .
Factors that can trigger a relapse in MS are: seasonal (_ and _); _; _ and/ or _ stress; _; and _ (avoid _, _ whirlpools and showers, _ _, and be aware of the temperature _ _ _)
Factors that can trigger a relapse of MS are:
- seasonal (SPRING AND SUMMER)
- INFECTIONS
- PHYSICAL and/ or EMOTIONAL stress
- PREGNANCY
- HEAT (avoid SAUNAS, HOT whirlpools and showers, HOT PACKS, and be aware of the temperature IN THE CLINIC)
Common signs and symptoms of MS include (in order of most to least common): change in _ (_, _, and ); rapid onset of _ _ pain or _ loss ( neuritis); _ vision; _ unsteadiness; _ problems
- Change in SENSATION (ARM, LEG and FACE)
- Rapid onset of UNILATERAL EYE pain or VISION LOSS (OPTIC neuritis)
- DOUBLE vision
- GAIT unsteadiness
- BALANCE problems
Other common signs and symptoms of MS: _ and _ dysfunction, loss of _ function, _, muscle _ and _, _, _, _, and clinical _.
- BOWEL AND BLADDER dsyfunction
- Loss of MUSCLE function
- NYSTAGMUS
- muscle SPASMS and TREMOR
- FATIGUE
- ANXIETY
- ANGER
- clinical DEPRESSION
Precautions for MS: avoid _ and _ _ or _ _.
Avoid FATIGUE and HEAT APPLICATION or OVER HEATING
Contraindications for MS: Avoid _ testing/ techniques especially the _ test and _ _ _/ _ test
- avoid NEURODYNAMIC testing/ techniques
- especially the SLUMP TEST and the PASSIVE NECK FLEXION/ LHERMITTE test
_ may result in loss of consciousness, especially following or during exercise. This is a _ _.
HYPOGLYCEMIA may result in loss of consciousness, especially following or during exercise.
This is a MEDICAL EMERGENCY
_ when uncontrolled can lead to reduced tissue healing.
HYPERGLYCEMIA
What are the guidelines for hypoglycemia, normal and hyperglycemia? Recommended range for children?
Hypoglycemia: LESS THAN 50 mg/dl
Normal: 60-120 mg/ dl
Hyperglycemia: GREATER THAN 180 mg/ dl
Children: 70-140 mg/ dl
Should never _ _ _ _ in the pool. Also be careful with patients that have?
Should never LEAVE DIABETIC PATIENT UNATTENDED in the pool
Also be careful with patients that SEIZURE DISORDERS
_ _ is another complication of DM II that can affect patient treatment.
PERIPHERAL NEUROPATHY is another . . . .
_ _ _ is a life-long condition that can occur at any age, affects women more commonly than men. Signs and symptoms include twitching, tingling, burning sensation in the legs, the urge to move the legs and difficulty falling asleep.
RESTLESS LEG SYNDROME is a life long condition . . . .
Restless leg syndrome: cause? Worse at? Aggravated by? (2)
Cause is unknown, thought to be related to dopamine system
Worse AT NIGHT/ BEDTIME
Aggravated by: SITTING OR LYING DOWN
PT treatment for restless leg syndrome include: _ or _ knee joint, especially at _; -; _ and _.
Include:
- EXERCISING OR MOVING knee joint, especially at NIGHT
- SELF-MASSAGE
- STRETCHING and WALKING
Restless leg syndrome can sometimes occur on a short term basis in patients post _, usually resolves within - _ post _
Can sometimes occur in the short term in patients post TKA, usually resolves within 4-8 WEEKS post SURGERY
Symptoms of restless leg syndrome are often similar to _ _ _ or _ pathologies.
Are often similar to OTHER ORTHOPEDIC or VASCULAR pathologies
_ is the #1 most abused drug in US. Acts as a _ _.
ALCOHOL is the #1 most abused drug in the US
Acts as a CNS DEPRESSENT
4 main symptoms of alcohol dependence: loss of _; _; _, drinking _ _ for the _ _; and physical _
Symptoms:
- loss OF CONTROL
- CRAVING
- TOLERANCE, drinking GREATER AMOUNTS for the SAME EFFECT
- physical DEPENDENCE
Clinical presentation of Alcohol dependence: _ behavior, _ for _, arrive at PT on the _ /, reoccurring -, _ of alcohol, or arrives at PT appt. _.
Clinical presentation:
- INAPPROPRIATE behavior
- LATE for APPOINTMENTS
- arrive at PT on the WRONG DATE/ TIME
- reoccurring FLARE-UPS
- SMELLS of alcohol
- arrives at PT appointment IMPAIRED
_ _ is a type of nerve damage brought on by chronic abuse of alcohol.
ALCOHOLIC NEUROPATHY is a type of nerve damage. . .
What other condition can read as ‘drunk’ on a breathlizer?
Hyperglycemia
What are the #1 and #2 most common complaints seen in US doctors offices?
1- LOW BACK PAIN
There is a high incidence of _ seen in the PT patient population
High incidence of DEPRESSION seen in the PT population
What are the 4 most common physical symptoms associated with depression?
VH BM
- Vague aches and pains
- headache
- back/ neck pain
- muscle pain
69% of diagnosed depressed patients report _ _ _ as their chief presenting complaint. 43% suffer form _ _ _ _.
69% Report UNEXPLAINED PHYSICAL SYMPTOMS as their chief complaint
43% suffer from CHRONIC PAINFUL PHYSICAL CONDITIONS
_ _ _ is the leading cause of disability in the US (ages 18-44) and it affects twice as many _ than _.
UNIPOLAR MAJOR DEPRESSION is the leading cause of . . .
It affects twice as many WOMEN than MEN
Previous or family history, change in functional/ occupational/ social status, female gender, post partum, and current substance abuse are all?
Are all risk factors for DEPRESSION
Criteria for major depressive episodes _/ _ symptoms for greater than _ _. Of the _, at least one must be 1 or 2
Criteria for major depressive episodes is 4/8 symptoms for greater than 2 WEEKS
Of the 4, at least one must be #1 or #2 on the list
What are the #1 and #2 signs and symptoms for depression screening?
- depressed mood
- marked or diminished interest or pleasure
Depression can manifest as _ _
Can manifest as NIGHT PAIN
Clinical relevance (PT) in depressed patients: _ _ depression, recognize _ patients. PT’s goal is to _, and set - goals and get / involved (requires _ _ first)
- RECOGNIZE depression
- Recognize SUICIDAL patients
PT’s goal is to ACKNOWLEGE, and set SHORT-TERM goals and get FAMILY/ CAREGIVER involved (requires PATIENT PERMISSION first)
_ is the second leading cause of the death in the US in people 15-24
SUICIDE
Male, over 45 yo, divorced/ single, sense of hopelessness and stressful occupation are all characteristics of?
All characteristics of people that are more often successful at committing suicide
3 parts of the clinical presentation for Suicide?
- Ideation
- Plan
- Resources available to follow through
What should/ can you do if you fear that one of your patients has suicidal ideations/ plan/ resources to follow through? (3)
- call county services (only open 8-5)
- call police
- call patients MD (can have patients held for a min. Of 72 hours)
What are the 2 special questions that are the best to ask on intake form to screen for depression/?
During the past month have you been bothered by feeling down, depressed or hopeless?
During the past months have you been bothered by having little interest or pleasure in doing things?
_ _ is a temperature dependent dermatitis resulting in vasospasm of the digital arteries following cold exposure. Has _ _ underlying condition.
RAYNAUD’S DISEASE is a temperature dependent . . .
Has NO APPARENT underlying condition
_ _ includes lupus, RA, TOS, CTS, drug reaction, following frostbite or primary pulmonary HTN. Is _ _.
RAYNAUD’S PHENOMENON includes lupus, RA, etc. . . .
Is DISEASE ASSOCIATED
What are the most common causes of chronic headaches: migraines? Tension headaches? Cervical (cranial) dsyfunctions.
Migraines- common cause is VASCULAR IN ORIGIN
Tension- common cause is due to MUSCLE CONTRACTION
Cervical/ cranial dsyfunction- common cause is the C0-C3 origin (cervicogenic headache)
_ _ often cause pain behind brow bone and/or cheek bone.
SINUS HEADACHES . . .
_ _ cause pain around one eye, and can also cause _ of the _, _ and _ on the same side as the pain. _ _ cause pain that is like a squeezing band around the head, with pain often worsening _ the _ and may increase with _ or _.
CLUSTER HEADACHES cause pain around one eye, and can also cause DROOPING of the EYELID, TEARING and CONGESTION on same side as the pain.
TENSION HEADACHES cause pain that is like a squeezing band around the head, with pain often worsening THROUGHOUT the DAY and may increase with LIGHT OR NOISE
_ _ can cause pain, nausea, and visual changes are common in the classic form. Pain often occurs around the _ _ _
MIGRAINE HEADACHES can cause pain . . .
Pain often occurs around the TRIGEMINAL NERVE DISTRIBUTION
More than / of headaches seen in general practice offices are attributable to a _ _ _ _.
More than 1/3 of headaches seen in general practice offices are attributable to a SERIOUS UNDERLYING NEUROLOGIC DISEASE
What are the 2 biggest fears in patients with chronic headache? _ _ rarely cause headaches.
1- brain tumor; 2- stroke/ anuerysm
BRAIN TUMORS rarely cause headaches
A _ or _ _ is precedes a subarachnoid hemorrhage. Is often described as _ _ of _. The mean interval between a _ _ and a subarachnoid hemorrhage is _ _.
A SENTINEL OR THUNDERCLAP HEADACHE precedes a subarachnoid hemorrhage.
Is often described as the WORST HEADACHE OF LIFE
The mean interval between a SENTINEL HEADACHE and a subarachnoid hemorrhage is 11 DAYS
Conditions associated with headaches that require a physicians referral: head and facial pain associated with _ and _ _ to PT; head pain preceded or associated with a _ of _; head pain associated with _ of _ _ (in a patient over 60 yo); head or facial pain with _ _; head or facial pain with _ _.
- head and facial pain associated with TRAUMA and NOT RESPONDING to PT
- head pain preceded or associated with a LOSS OF CONSCIOUSNESS
- head pain associated with TENDERNESS of SCALP ARTERY
- head or facial pain with CN INVOLVEMENT
- head or facial pain with NEUROLOGICAL DSYFUNCTION
_ _ or _ _ _ can mimic TMJ disorders, if symptoms are also accompanied by _ with _ and a _ _ near _ you should _ _. Incidence is _%
TEMPORAL ARTERITIS (GIANT CELL ARTERTIS) can mimic TMJ disorders, if symptoms are also accompanied by PROBLEMS WITH HEARING and a PROTRUDING ARTERY near TEMPLE you should REFER IMMEDIATELY
Incidence is 15%
_ _ (_) or _ _ is an enlargement of the normal opening for the esophagus in the diaphragm that allows part of the stomach to protrude into the chest cavity
HIATAL HERNIA (DIAPHRAGM) OR ABDOMINAL HERNIA is an enlargement . . .
Increased intra-abdominal pressure, lumbar bracing/ corsets, lumbar stabilization programs, inverse traction or double knee to chest in supine are all?
All examples of AGGRAVATING FACTORS for ABDOMINAL HERNIA
What are easing factors for an abdominal/ hiatal hernia?
Elevate the head of the bed/ plinth
Abdominal/ hiatal hernia can cause _ _ or _ _ pain. What other condition could have the same symptoms.
Can cause CHEST PAIN or HEART BURN pain.
Mimics symptoms of a heart attack, need to differentiate was it food related or cardia related.
What is the physical sign of hernias? Don’t want to _ _ _, or cause _ to _. They have a _ _ _.
Lumps on the abdomen
Don’t want to MAKE IT WORSE or cause REPAIR TO FAIL. Repairs have a HIGH FAILURE RATE
Watch out for _ _ in patients with abdominal hernia. Can cause _ of the bowel, and intermittent _ or _ of the abdominal contents. If there is _ _ _, _ pain, _, _ and _- immediately refer to physician.
Watch out for ISCHEMIC PAIN in patients with abdominal hernias. Can cause STRANGULATION of the bowel, and intermittent TRAPPING OR PINCHING of the the abdominal contents.
If there is INGUINAL MASS TENDERNESS, WORSENING pain, NAUSEA, VOMITING and FEVER- immediately refer to physician
_ _ occurs when a portion of the small intestine enters the inguinal canal. Usually found just _ _ _.
INGUINAL HERNIA occurs when a portion of the small . . .
Usually found just ABOVE INGUINAL LIGAMENT
What are 4 common areas where abdominal hernias are found?
Epigastric, umbilicus, inguinal (above the inguinal ligament) and femoral (below inguinal ligament/ femoral triangle)
_ _, _ _ or _ _ is one of the most frequent sports injuries and leads to a localized bulge (inferiorly and posteriorly), induces compression of the genital branch of the genitofemoral nerve. Will have _ and _ pain
SPORTSMEN’S GROIN, SPORTS HERNIA, and GILMORE GROIN is the most frequent sports injuries . . . .
Will have GENITAL and ADDUCTOR pain
Sportsmen’s groin can also affect the _ _. Can happen to _ as well.
Can also affect the OBTURATOR NERVE
Can happen to WOMEN as well
Treatments that would be suitable for patient with posterior rotated innominate with abdominal hernia: you _ do MET but _ _ _, or _ _ of the _.
You CAN do MET but USE LESS FORCE
Or PASSIVE ROTATION of the INNOMINATE
_ _ can occur in the stomach or the duodenum or esophagus. Can cause abdominal _ with a _, _ ache that has a _ of _ / _.
PEPTIC ULCERS can occur in the stomach or duodenum of both . .
Can cause abdominal DISCOMFORT with a DULL GNAWING ache that has a PERIOD of REMISSION/ EXACERBATION
Differential dx of peptic ulcer location: if it is in the _ _ pain will occur 30-60 minutes after eating, if it is in the _ or _ _ in the _ it will cause pain 2-3 hours after eating.
Peptic ulcer location:
-if it is in the STOMACH LINING pain will occur 30-60 minutes after eating
-if it is in the DUODENUM, or FURTHER DOWN in the TRACT it will cause pain 2-3 hours after eating
Aggravating factors for peptic ulcer would include _ stomach, and _ food. Easing factors: _ or _ medication.
Aggravating Would include:
-EMPTY stomach and SPICY food
Easing factors:
-EATING or ANTACID medication
If patients gets pain after eating spicy food on the left it is probably? If on the right its probably?
Left- STOMACH
Right- GALL BLADDER
Emergency Symptoms for Peptic Ulcer: _, _ _ stomach pain; , _ stools, _ ( or like _ _)
Emergency symptoms:
- SHARP, SUDDEN PERSISTENT pain
- BLACK, TARRY stools
- VOMITING (BLOODY or like COFFEE GROUNDS)
Differences b/w stomach and duodenal peptic ulcers in type/ quality of pain?
Stomach- BURNING PAIN
Duodenal- NOCTURNAL
The _ _ is a collection of glands that produce chemical messengers (hormones) that regulate body functions.
The ENDOCRINE SYSTEM is a collection . . .
Endocrine system regulates _, _, and _ _.
Regulates METABOLISM, GROWTH, and SEXUAL DEVELOPMENT
What are 4 signs and symptoms of thyroid/ endocrine system pathologies that mimic/ are the same as other orthopedic dysfunctions.
JuMPiN
JOINT PAIN
MUSCLE PAIN
PARATHESIA
NEUROPATHIES
Patients with endocrine pathologies may also have _, _ skin, brittle _/ _ and usually _ _ (in addition to other Ortho symptoms)
May also have:
- DRY SCALY skin
- brittle HAIR/ NAILS
- usually BRUISE EASILY
What is the most common type of thyroid disease?
Hypothyroidism
Patients with hypothyroidism in subjective exam will complain of _, _ pain, _ and _. Will often also have _ _ and _
Will complain of FATIGUE, JOINT PAIN, WEAKNESS and PARATHESIA
Will often also have SWOLLEN KNEES and FEET
Patients with Hypothyroidism are also prone to more _ conditions such as _ _ syndrome or parathesia especially in _.
Prone to more NEURAL conditions such as CARPAL TUNNEL SYNDROME or parathesia especially in CALVES
Hyperthyroidism causes _ of the thyroid gland and is often characterized by _ or _ (_ eyes). Signs and symptoms include _ _, _, _ symptoms, _ loss and _.
Causes ENLARGEMENT of the thyroid gland and is often characterized by GOITER or EXOPHTHALMOS (BULGING eyes)
S and S include: HEAT TOLERANCE, TREMORS, CHEST symptoms, HAIR loss, and ANXIETY
If the nodule on the thyroid produces too much hormone it is classified as? %?
Classified as HOT- 5%
Hypothyroidism can cause weight _, hyperthyroidism can cause weight _
Hypo- weight GAIN
Hyper- weight LOSS
Patients with Hyperthyroidism may have weakness of the _ _ of the _ during MMT, as well increased _.
May have weakness of the PROXIMAL MUSCLES of the EXTREMITIES during MMT, as well increased SWEATING.
In patients with a long history of diagnosed hyperthyroidism precautions/ contraindications for therapy include: _, _, and the _ test due to demineralization of bone.
Include: PAIVM, PPIVM, and the SLUMP TEST due to bone demineralization
A known history of malignancy should always raise concern if associated with any _ _ _ .
If associated with any NEW SKELETAL PAIN
In patients with low back pain what is the incidence in the direct access population of pain being caused by a non-musculoskeletal condition?
Approx. 3%
In patients with RA you should avoid: forceful and/or sustained _ _ and _ _ to _.
Should avoid:
Forceful or sustained CERVICAL FLEXION
VERTEBRAL PRESSURES to C1
RA usually affects joints _, may initially begin in a _ _ only. Most frequent attacks occur in the _, _, _, _ and _ (aka _)
RA usually affects joints BILATERALLY, may initially begin in a COUPLE JOINTS only
Most frequent attacks occur in the HANDS, WRIST, ELBOW, SHOULDERS, KNEES AND ANKLES (AKA- limbs)
Differentiating OA from RA: OA can affect the _, pain worsens with _ _ and eases with _ and symptoms occur in _ only.
OA can affect the SPINE, pain worsens with PROLONGED EXERCISE, and eases with REST and symptoms occur in JOINTS ONLY
Differentiating RA from OA: RA pain is worse with _ _ and better with _, and it affects the _ and _ _ of the _. Can also cause _.
RA pain is worse with PROLONGED REST and better with EXERCISE, and it affects the JOINTS AND OTHER PARTS of the BODY
Can also cause FATIGUE
OA attacks _ and RA attacks _ _
OA- CARTILAGE
RA- SYNOVIAL MEMBRANE
_ is a viral infection that causes a painful rash. Usually affects _ _, most commonly in the _ or _ _.
SHINGLES is a viral infection that causes a painful rash
Usually affects ONE DERMATOME, most commonly in the FACE or RIB CAGE
Meningitis can cause _ neck, positive _ sign and intense _ that mimic other musculoskeletal disorders.
Can cause STIFF neck, positive SLUMP sign and INTENSE HEADACHE that mimic . . .
In addition to musculoskeletal symptoms patients with meningitis will also have a _, _ and _ and _.
Will also have FEVER*, VOMITING and NAUSEA, and RASH
Earliest signs of meningitis: _ _ symptoms followed by _ in _ with _ _ soreness.
FLU-LIKE SYMPTOMS followed by STIFFNESS in NECK with SEVERE MUSCLE soreness
