Virtual class topics 21-30 Flashcards
What happens to lung volumes in obstructive diseases
TV increases
RV increases
FRC increases
TLC increases
Describe ankle ABI scoring
Falsely elevated >1.2 = arterial disease and diabetes
Normal - 1.19-.95
Mild - .94-.75
Moderate - .74-.50
Severe <.50
Describe arterial and venous insufficiency presentation
In terms of:
Cause
Location
Appearance
Pain
Ulcer
Complications
Arterial insufficiency
- Inadequate blood flow
- Lateral malleolus
- Pale wound, well defined edges
- Intense, worse with elevation
- Minimal exudate, dry, shiny skin, hair loss
- Gangrene, amputation risk
Venous insufficiency
- Poor blood return due to damaged veins
- Medial malleolus
- Pink, red, irregular shape, shallow edges, hemosiderin staining
- Minimal pain, relieved by leg elevation
- Moderate/heavy exudate, swelling, skin discoloration
- Cellulitis, venous stasis dermatitis
Describe the claudication grading scale
Grade 1
Initial discomfort, minimal pain
Grade 2
Moderate discomfort, attention can be diverted
Grade 3 - stop exercise, resume once pain subsides
Intense pain, attention cannot be diverted
Grade 4 - stop activity, refer to physician if pain persists
Excruciating pain, unbearable
Hello
Good bye
What are some intervention strateges for obstructive lung pathologies
Activity pacing
Pursed lip breathing
Promote huffing
Inhalation of corticosteroids, bronchodilators
What are some intervention strateges for restrictive lung pathologies
Ventilatory support
Respiratory muscle training / chest expansion exercises
Managing medications and their side effects
Describe fremitus, assessment and interpretation
Vibratiry tremors that can be felt through the chest by palpation
Assess by saying 99 and palpating the chest
Decreased fremitus
Indicates more air in the lungs
Increased fremitus
Indicates increased fluid in lungs
Describe chest percussion, assessment and interpretation
Tapping of pt chest walls
Hyperresonant to percussion (louder) - indicates more air in that area
Dullness to percussion - indicates increased secretions
Describe the difference between pneumothorax and atelactasis
Pneumothorax
Collection of air outside the lungs but in pleural cavity
Pushes trachea to opposite side
Atelectasis
lung collapse caused by blockage of air
Attracts trachea to affected side
Briefly describe Asthma, emphysema and hemothorax
Asthma
Acute narrowing of airways
Wheezing present
Emphysema
Permanent alveolar damage
Air trapped in lungs, more than in chronic bronchitis
Hemothorax
Blood in the pleural space
Describe L and R sided heart failure presentation
R sided
Peripheral edema
Enlarged liver - hepatomegaly
Abdominal discomfort
Jugular vein distention
Fluid retention
L sided
SOB
Fatigue and weakness
Orthopnea - SOB in supine
Paroxysmal nocturnal dyspnea
Cough, pink, frothy sputum
What level of table elevation will taget the middle and lower lobed during postural drainage
Middle lobe - Foot elevation of 12 inches
Lower lobe - foot elevation of 18 inches
Describe the cardic rehab phases
Phase 1
Medically stable patient after MI, CABG, PTCA, valve repair, heart transplant
FITT
F - 2-3 per day
I - 50-70% HR max
T - 10-15 mins, (30 mins phase 2)
T - ADLs, supervised ambulation
Phase 2
24 hours after discharge, lasts up to 6 weeks
Phase 3
Begins at end of phase 2 and extends indefinitely
Resistance training begins
FITT
2-3 sessions per week
70-85%
30-60 mins
Walking, treadmill, cycle
Resistance training can begin this phase
1-3 lbs of elastic bands and light hand weights
8-10 reps, progress to 12-15
Avoid upper extremity resistance as soft tissue is still healing
Phase 4
Exercising in community
50-85% functional capacity
3-4 times per week
45 mins or more
Discharge from supervision in 6-12 months
Describe weight reduction exercise guidelines
F - 5-7 days per week
I - 40-60% VO2
T - 45 - 60 mins per session, 250-300 mins per week
T - Aerobic and resistance exercise
List and describe the types of studies by strength of evidence in descending order
Meta analysis
Synthesis of huge body of evidence
Statistics performed to determine outcomes
Systematic review
Summary of many papers
No statistical review
RCT
Used to determine the efficacy of an intervention
Cohort studies
Observe two different groups of people over time and compare outcomes
Case control studies
Compares a group of individuals with a specific condition with a group of people without the same condition
Cross sectional analysis
Observational study where the investigator measured outcome and exposure in the participants at the same time
Case series / case reports
Document clinical case of a single patient or a series of patients
Describe qualitative data and its types
Qualitative
Analysis of non-numerical data
Statistical analysis not performed
Interested in emotional or subjective experiences
Nominal - names
Data that can be organized into mutually exclusive groups with no overlap
EX: Gender, blood type, hair color
Ordinal
Data organized by ranking system, spaces between categories in system not meaningful, rank itself only important
EX: MMT grades, level of assistance, joint laxity grades
Describe quantitative data and its types
Quantitative
Collecting and analyzing numerical data
Analysis of quantifiable outcome measures
Statistical analysis performed
Interval
Data that is ordered in ranking system and space between rankings meaningful
No true 0
EX: temperature
Ratio
Data organized in ordered ranking system, meaningful space between rankings with a true 0, negative values not possible
EX: Height
Describe validity
In terms of:
Content
Construct
Concurrent
Face
Construct validity
Does the test measure the thing (construct) you want to measure
Content validity
Does the test measure all relevant parts of the construct
Concurrent validity
Comparing the new measure to the current gold standard
Face validity
Does an outcome measure appears like it measures what it should
Describe the types of error
Type 1
False positives
Incorrect rejection a true null hypothesis
Type 2
False negative
Failing to reject a false null hypothesis
Describe speceficity and sensitivity
Sensitivity
Ability of a test to identify true disease
Snout
Specificity
Ability of a test to correctly identify absence of a disease
Spin
Describe the peripheral nerve sensation to the hand
Radial
- Lateral 3.5 fingers, dorsal side, not tips
- Lateral part of dorsal hand
- Wraps around base of thumb, most lateral postion of thenar eminance on volar surface
Median
- Lateral 3.5 fingers, volar side, tips of fingers dorsal side
- Thenar eminence, lateral palm
Ulnar
- Medial 1.5 fingers, dorsal and volar surfaces
- Medial part of volar and dorsal hand
Describe peripheral nerve sensation to the lower leg and foot
Tibial
-Heel of foot
Deep peroneal
-1st web space
Superficial peroneal
-Dorsum of foot (except first web space)
- Anterolateral part of lower leg
Sural
-Posterolateral leg
Saphenous
-Medial lower leg
What are some peripheral vestibular pathologies
BPPV
Vestibular neuritis
Labyrinthitis
Acoustic neuroma
Describe BPPV and what are its causes
When the otolith crystals get stuck in the semicircular canals
Infection, head trauma, Vestibular weakness, advancing age
Describe the dix halpike test and its interpretation
Duration of symptoms?
Turn pt head 45 degrees to side you wish to test
Move pt into supine position with head extended
Upbeating torsional nystagmus - posterior canal
Down Beating torsional nystagmus - anterior canal
Canalithiasis
Symptoms last a short duration, less than 1 minute
Cupulolathiasi
Symptoms last longer than 1 minute
Describe the supine roll test and its interpretation
Pt in supine, 30 degrees flexion
Rotate head toward testing side and assess for symptoms
Geotropic - beats toward ground - canal - stronger = affected
Ageotropic - beats away from ground - cupulo - weaker = affected
Describe epley’s manuever
Used to treat BPPV in the posterior canal
- Turn head to affected side
- Lay pt in supine with head 20-30 extended
- Turn head 45 opposite way
- Roll onto shoulder head is facing, maintain nose down
- Sit pt up
Describe the treatment strategy for cupulolithiasis
Semont maneuver / liberatory maneuver
Turn head 45 degrees opposite of affected side
Lay in side lying on side pt is not looking, remain here for 1 min
Quickly move pt 180 degrees to side lying on opposite side
Return to sitting after 1 min
Describe the brandt darroff exercise
Alternating side lying while looking toward the ceiling
Used when pt cannot tolerate epley / semont
Describe treatment for horizontal canal BPPV
Supine, 20 degrees cervical flexion
Turn head 90 degrees to affected side
Turn head back to neutral
Turn head to unaffected side
Roll towards unaffected side into prone
At each step wait for symptoms to resolve
What is the name of the treatment used for horizontal canal cupulolithiasis
Gufoni manuever
What are the central vestibular pathology tests
Smooth pursuit -H test
Saccade - Look quickly between 2 target
If impairments present, this is a problem
