Special Topics

Question 1

What is cancer related fatigue?

Answer 1

Persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning

NOT acute fatigue, which is a physiologic response, recoverable

Question 2

What are the most common side effects experienced by patients during radiotherapy?

Answer 2

1) Fatigue
2) Drowsiness
3) Pain

Question 3

What psychological disorder do the mental and emotional effects of CRF resemble?

Answer 3

Depression

Question 4

What aspects of life does CRF impact?

Answer 4

Occupational, social/behavioral, mental/emotional, including many commonly performed activities and ADLs

Question 5

What are common PT treatments for lymphedema?

Answer 5

Manual lymph drainage
Exercise
Pressure garments & pneumatic pressure pumps

Question 6

What is the basic physiologic explanation for swelling (including lymphedema)?

Answer 6

Filtration exceeds absorption, as explained by Starling’s Forces

Question 7

What is the definition of lymphedema?

Answer 7

An abnormal accumulation of protein-rich fluid due to mechanical insufficiency of the lymphatic system

Question 8

Lytic bone lesions are common with which forms of CA?

Answer 8

Multiple myeloma

Bone metastasis

Question 9

What are the common signs and symptoms associated with fracture?

Answer 9

Pain with weight bearing
Pain in the groin
Pain with hip scour
Pain with hip external rotation and abduction
Pain with deep inspiration
Pain in a band around the chest wall
Increased pain with supine
Increased pain with valsalva

Question 10

How can CA result in spinal cord compression?

Answer 10

Can be a primary or secondary phenomenon:
Direct invasion
Disruption of vascular supply
Vertebral collapse

Question 11

What are the common signs and symptoms associated with spinal cord compression?

Answer 11

Pain that increases when lying supine
Pain with valsalva
Escalating back pain
Motor weakness
Sensory deficits
Bowel/bladder dysfunction
Hyperreactive reflexes

Question 12

What are the main areas of examination of CA-related pain?

Answer 12

Temporal
Intensity
Topography (location)
Quality

Question 13

What are the terms to describe elevated and depressed WBC?

Answer 13

Leukocytosis and leukopenia

Question 14

What are the terms to describe elevated and depressed platelets?

Answer 14

Thrombocytosis and Thrombocytopenia

Question 15

What are the terms to describe elevated and depressed RBS?

Answer 15

Polycythemia and Anemia

Question 16

What symptoms might you expect when working with a patient with anemia?

Answer 16

Decreased cardiopulmonary reserve/ limited endurance

Exercise intolerance/ DOE/ tachycardia/ pallor

Question 17

Is physical therapy contraindicated in pt’s with “severe” anemia (< 8 g/dL)

Answer 17

Perhaps, per some facility’s policies and procedures; in actuality, PT should be fine until lower levels are reached (< 5 g/dL?)

Question 18

What is the normal physiological response to anemia?

Answer 18

↑ CO  ↑ HR & ↑ SV
↑ SV  ↓ blood viscosity &↓ vascular resistance = ↓ afterload stresses)

Acute reduction of blood Hb concentration to 50 to 60 g/L (5-6 g/dL) does not result in detectable inadequate systemic O2 delivery

Question 19

What is the risk of mortality with anemia?

Answer 19

Mortality increases as Hb drops, but does not become significant until 5-6 g/dL

Question 20

What are the common signs and symptoms associated with an acute transfusion reaction?

Answer 20

Signs:
Shock/hypotension
Facial flushing
Fever, chills
Oliguria/ renal failure
Bleeding 

Symptoms:
Abrupt onset
Nausea/Vomiting
Anxiety
Pain in back or flanks
Dyspnea

Question 21

What are the steps of hemostasis?

Answer 21

Vessel injury
Vascular spasm
Platelet plug (primary hemostasis)
Coagulation (secondary hemostasis)

Question 22

What are the recommended PT interventions for a patient with thrombocytopenia (ordered from mild to severe)?

Answer 22

Low intensity progressive resistive exercise (PRE) and aerobic exercise (none to minimal elevations/ resistance)

AROM exercise, walking ad lib

Risk of spontaneous bleeding, petechia, ecchymosis and prolonged bleeding time.
Therapy may be contraindicated/ minimal AROM
No brushing of teeth