Multisystem Conditions Flashcards

1
Q

Male and female top cancers

A

Male: prostate, lung, colon

Female: breast, lung, colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

TMN cancer staging

A

0: carcinoma in situ
1-3: extend beyond where it has developed
4: spread to different organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chemotherapy side effects?

A

Alopecia, mucositis, pulmonary fibrosis, cardio toxicity, renal failure, sterility, myalgia, neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Radiation side effects

A

Skin irritation, scar tissue, hair loss, temp change in skin colour, Fatigue, swallowing discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

5 main treatments for cancer

A
Surgery
Chemotherapy
Radiation
Hormone replacement sx
Biological or genetic tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Clinical presentation of patient with Cancer

A
  • ROM limitation
  • Fatigue
  • Myalgia
  • Arthralgia
  • chemo induced peripheral neuropathy
  • ## deconditioned
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PT management of Cancer

A
  • Fatigue management
  • fxn and mobility management
  • physical symptoms management
  • psychological symptom management

Rehab: preventative, supportive, restorative
Acute sitting: mobility (equipment), strength, bed positioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Exercise precautions for a cancer patient

A

Swollen ankle, fatigue, committing and diarrhea, unexplained weight loss/gain, SOB with low levels of exertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Contraindications to exercise for Cancer patient

A
  • racing pulse, fever, pain in back, neck, bones, calf pain, Chest pain, nauseated while exercising, confused or disorientated, dizzy/faint, blurred vision, sudden SOB, very weak and tired
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If a person has Mets what Q’s need clarifying?

A
  • Weight bearing orders (not just AAT)

- neurological symptoms ( b/b, pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Normal Hb levels for male and females

At what level does exercise need to be scaled back?

A

Male: 14-18 g/dl
Female: (12-16 g/dl)

Precaution when Hb is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the effect of Anemia?

A

Effects amount of O2 that can be carried to the cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Neutropenia?

A

Decrease in WBC related to body’s ability to fight infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Neutropenia: normal WBC #, point of infection risk.

Exercise precautions

A

Normal WBC >1000mcL

Infection risk increase if absolute neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Thrombocytopenia

A
  • Low platelet count (normal = 150-400,000 mcL) increases bleeding/ bruising risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Exercises dependent of platelet levels

A

If

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the function of lymphatic system

A

Removal of fluids, proteins, bacteria, viruses

  • smooth mm in walls contract to move lymph
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Differentiate the two types of lymphodema

A

Primary:
- rare, inherited condition that development problems occur in lymph vessels

Secondary:
- D/T damage to or obstruction to normally functioning lymph vessels and nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Risk factors for Lymphedema

A

Radiation

  • Axillary node dissection
  • arm infection/virus (primary)
  • wight gain since operation
  • obesity (bmi >25)
  • older age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How to measure Lymphedema

A
  • circumferential (>2cm)
  • water deplacement
  • perometer and bioelectrical impedance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the goals of Palliative care, what can we help with?

A

Goal: comfort, support, maximize independence

Can aid with: respiratory, stress reduction, education

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ways that HIV AIDS is transmitted

A
  • blood, saliva, semen, CSF, breast milk, vaginal secretions, mucous membrane, mother to child during pregnancy

Not by: urine, sweat, vomit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Common conditions associated with AIDS

A

Pneumonia, TB, malignancy, encephalitis, meningitis, dementia, herpes zoster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

treatment for AIDS?

A

Med Rx:

  • multiple antiviral therapy
  • symptomatic tx: nutrition, functional mobility, education

PT management:

  • mod aerobic & strength
  • avoid exhaustion
  • energy and stress management if acute
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Pathology of autoimmune disorder Guillain-barre

A

Antibody mediated demyelination of Schwann cells in PNS from spinal nerves to terminating fibres

  • possible hospitalization of 6-8 months

Cause: immune disorder (2/3 from recent illness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

GB s/s

A
  • Rapid ascending motor weakness and distal sensory loss (starts in legs and spreads to arms, trunk, face)
  • ataxia
  • stocking and glove pattern of loss
  • paralysis
  • absent DTR
  • may require ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

GB management

A

Medical: Plasmaphoresis, immunoglobin

PT:

  • positioning to decrease ulcers
  • joint protection
  • chest Rx, mobilization
  • strength
  • ROM (opposite progression of ALS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is Lupus erythematosus?

A

A system autoimmune connective tissue disorder involving the skin and other systems ( kidney, CNS, Cardiac, pulmonary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Lupus erythematosus s/s

A
  • skin rash (butterfly)
  • localized erythema
  • localized edema
  • arthritis
  • alopecia
  • photo sensitivity
  • mucous ulcers
  • Raynaud’s
  • joint effusion

Dx: +ve serum “antinuclear antibodies” symmetric arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is Sclerodema (systemic sclerosis)

A
  • Chronic disease primarily affecting skin, characterized by sclerosis (hardening of skin) via a massive fibrotic tissue response.

Can cause:

  • joint contractures, pulmonary fibrosis, HTN
  • renal, GI dysmotility (esp esophageal), Raynaud’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Differentiate b/w Dermatomyositis and polymyositis

A
  • Dermatomyotositis = skin+ muscle, photosensitive skin rashes, purplish erythematous eruption over face & UE
  • Polymyositis = muscle only
  • inflamed connective tissue disorder characterized by proximally limb girdle weakness, often without pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are 3 causes of hemophilia?

A

Hereditary bleeding disorder

1) vascular abnormalities
2) platelet abnormalities
3) coagulation cascade abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Discuss type A hemophilia?

A
  • most common of hereditary clotting factor deficiencies

X-linked recessive = males have condition, females carry the gene
- if mom is carrier & father doesn’t: 50% chance male will have disorder, 50% female will be carrier

If mother is not carrier & father has hemophilia: male not affected/ can’t carry gene. Female child will be a carrier known as an Oblagate carrier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Hemophilia S/S?

A

1 = bleeding in the joint

  • large bruises
  • bleeding into muscles and joints
  • prolonged blending after a cut
  • big trauma = big organ bleed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

S/S of patient with a joint bleed (hemophilia)

What can happen if not treated?

A

Stage 1) Joint tightness, no pain

2) tightness,pain , no bleeding
3) swollen hot to touch, hard to move joint
4) all ROM last + night splint

No Tx can lead to Arthritis

Tx= factor VIII infusion, desmopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Q’s to ask if querying a rheumatic disease?

A

1)Red flags:- #, septic arthritis, malignancy, central cord s/s, muscle weakness, burning/ numbness parasthesia

2) inflammation IN or AROUND joint?
- if in: effects multiple ROM, swelling is common, but no focal TOP
3) Focal or widespread?
4) Acute or chronic duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Is the condition “inflammatory” or “non-inflammatory” via s/s?

A

Inflammatory:
- worse in AM, mod-severe swelling, occasional erythema, warmth, morning stiffness =/>1hr, systemic features sometimes present, frequent increase in ESR erythrocytes sedimentation rate [RA])
Non inflammatory:
- pain worse after use, mild swelling, not red, not warm, stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Main feature of RA?

- pathology + leads to..

A

Synovitis (symmetrical pattern)

  • synovium swells and cells proliferate:
    1. Dense cellular membrane (pannus) spreads over articular cartilage
    2. Erosion of bone and cartilage
    3. w/ time pannus extends to opposite articular surface creating: 1) fibrous scar, 2) adhesions, 3) bony ankylosing

Leads to:

  • immobility + consolidation of a joint
  • bones become osteopenic
  • ligaments/ tendons become damaged or ruptured
  • mm deteriorating causing joint instability & deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Criteria for RA diagnosis?

A
  • morning stiffness >1hr
  • arthritis in >3 joints (6 weeks)
  • arthritis in hands
  • symmetrical arthritis
  • rheumatoid nodules
  • serum rheumatoid factors
  • radiograph if changes
  • abnormal antibody (HLA-DR4 [80% those w. RA])

HLA-DR4 also commonly found in pt with interstitial lung disease, hepatitis, pulmonary fibrosis,normal aging,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

S/S of RA?

A
  • pain, fatigue, stiffness (dec ROM), swelling, joint deformity, mm atrophy, extra cellular features.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How is RA managed?

A

MEDs:

  • DMARDS/ Biologics to stop disease process
  • Methotrexate to prevent permanent joint damage
  • NSAIDs: Tylenol, cortisone = to dec inflammation and pain, help ROM

REHAB!
Lifestyle
Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Discuss RA rehab?

A

Acute phase:
- energy conservation, ice, splints, gentle ROM (no stretching… May stretch the synovial membrane and cause irreversible damage)

Chronic phase:

  • relieve pain: Heat/ice, modalities
  • splints, exercise (ROM)
  • relaxation/rest
  • dec stiffness (ROM)
  • endurance exercises (in water?)
  • prevent deformity
  • fall prevention
  • physically active
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

4 R’s of sugery

A

Remove (MTP resection)
Re-align (tendon rupture)
Rest (arthrodesis)
Replace (arthroplasty)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Basics of a joint count Ax?

A

-indicator of RA disease activity via STOP method

  1. Joint effusion :2 or 4 finger technique
  2. Joint line tenderness
  3. Stress pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Commonly affect joints in RA?

A

1) Atlanto-Axial joint:
- Transverse ligament: s/s = clunking in repositioning in sharp purser test, dysphagia, dizziness, blurred vision
2) TMJ: end stage = fusion of open bite
3) shoulder: humeral head migrates superior ply
4) AC joint
5) elbow: flexion deformity
- superior radio-ulnar joint involved= erosion of radial head
6) hip: groin pain, flexion deformity
7) knee: baker’s cyst, flexion deformity, valgus deformity, quad wasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Classic RA Deformities

A
  • Hallux valgus
  • MTP subluxation
  • Claw toe
  • hammer toe
  • mallet toe
  • swan neck
  • boutonnière
  • ulnar drift
  • Thumb: 90/90 or swan neck
  • DRUJ instability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is Hallux valgus? + effect on foot

A

1st MTP synovitis, big toe is lateral, lig laxity + erosion

- subluxation, dislocation leads to proximal phalanx drifting laterally causing pronation of mid foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Discuss MTP subluxation

A
  • Synovitis causing displacement of flexors, then unopposed extensors pull the proximal phalanx into hyperextension. Metatarsal head prolapsed and get dislocation and Lat drift of toes

Sign: callouses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is claw toe?

A

MTP synovitis, MTP ext, PIP+DIP flexion

  • often all toes except big toe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is a hammer toes

A
  • MTP & PIP synovitis (usually 2nd toe), leads to flexion of PIP and hyperextension of DIP (similar to boutonnière)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is mallet toe?

A

Flexion of DIP (usually of longest toe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Features of a swan neck deformity.

A
  • Flexion of MCP, hyperextension of PIP, flexion of DIP
52
Q

Test & Rx for a SND

A

Test: Bunnel littler
Rx: able to actively flex & ext deformed joints, stretch interosseous muscles

53
Q

What is a boutonnière deformity? How do you test for it?

A

Zig Zag defomity: MCP hyperextension, flexion of PIP, hyper extension of DIP

Test: central slip

54
Q

Features of an ulnar drift deformity

A
  • most common hand deformity

- involves synovitis of MCP + structural differences cause collar subluxation of MCP in radial collateral ligaments

55
Q

Ulnar drift deformity: test + Rx?

A

Test:

  • radial collateral ligament test
  • extensor subluxation test

Rx: radial finger walking, joint protection.

56
Q

Common thumb deformities & tests

A

90/90 thumb, or SND

Test: grind, crank test

57
Q

Feature of DRUJ instability

A

Synovitis at joint, stretches ulnar carpal ligaments, ulnar head will sublux dorsally, ECU is displaced and may become a flexor tendon

Test: ballottement tests

58
Q

What is Gout?, common joints + Rx

A
  • genetic disorder of Purine metabolism
    Increased uric acid, forms crystals and deposits into joints

Knee + great toe most common

Rx: Meds: NSAIDS, cox2-inhibitor, CS, ACTH, Aspiration!

PT Rx: injury prevention, education

59
Q

OA: pathology + Risk factors

A

Release of enzymes + abnormal bio-mechanical forces = fibrillation + articular cartilage damage resulting in cartilage loss + increased bone turn over = osteophytes

Risks:
- Age, F>M, obesity, physical inactivity, injury, joint stress

60
Q

OA: main joints affected

A

Spine: osteophytes in facet joint of L-spine = stenosis
Hand:
- PIP = Bouchard node
- DIP = Hebenen’s node
- CMC joints (thumb)
Knee: varus, flexion contracture, crepitus
Hip: trendelenberg, groin pain, osteophyte, flexion deformity
Foot: 1st MT = osteophytes cause Hallux valgus + rigidus + bunions

Uncommon:
- shoulder/elbow, wrist (except if have scaphoid # or avacular necrosis) ankle

61
Q

OA: Dx

  • 4 main X ray findings
  • 4 important Q’s
  • tests indicative of knee OA
A

X-ray: kellgren-Lawrence

1) joint space narrowing
2) Osteophytosis
3) subchondral cysts
4) subchondral sclerosis

Q’s

  • Pain most days of the month?
  • pain over the last year?
  • worse with activity, over doing it?
  • relieved with rest but have “gelling” after inactivity

Knee tests:
- flexion contracture, abnormal gait, swipe test/ patellar tap +ve

62
Q

OA:

  • sources of pain?
  • RX:
A
  • pain from: bone, soft tissue, inflammation, mm spasm

Rx:

  • weight loss: 1lb weight loss= 4lb less through knee
  • Exercise: 30 min mod aerobic + LE resistance
  • protective aids, Tylenol, modalities…tens
63
Q

Two type of FAI? + features

A

Cam: “bigger femoral head and neck”
- w/ hip flexion the abnormal femoral head drives into the acetabulum usually in young men

Pincer: deeper acetabulum
- impingement when femoral neck pushes against overarching acetabulum usually affect women 30-40

64
Q

Spondyloarthritis: characteristics

A

Spine inflammation = spondylitis and sacroilitis
Synovitis –> unilateral peripheral joints
Eye inflammation = iritis/ uveitis & conjuctivitis

  • No rheumatoid factor (seronegative)
  • can be hereditary: HLA-B27
65
Q

Psoriatic Arthritis:

  • characteristics
  • types
  • Rx
A

Chronic, erosive, inflammation affecting fingers and axial skeleton

  • Dactylitis: sausage like fingers d/t swelling
  • Enthesitis: usually in heels and back

Med Rx: acetaminophen, NSAID, DMARD, CS, Biologics
PT Rx: joint protection, maintain joint mechanics, endurance

66
Q

Enteropathic Spondylits:

- related to…

A

Related to inflammatory conditions of the bowel

  • Ulcerative Colitis: affects lower half of bowels
  • Crohn’s disease: worse/ affect whole digestive system

Increase bowel disease = increase arthritis
Affects spine, SI, limbs

67
Q

Reactive arthritis:

  • triggers
  • characteristics
A

Triggered by: infection (STI) in bowel or GI tract

Features:

  • hot swollen joints: LE + symmetrical
  • may go away and return
68
Q

Ankylosing Spondylits:

A
  • Onset before 40, M>F
  • low back pain + sacroiliitis
  • kyphotic deformity of Csp,Tsp, dec lumbar lordosis
  • Diagnosis: HLA-B27
  • Meds: NSAIDs, CS, Biologics,cytotoxic
  • PT goals: trunk flexibility, endurance,increase Resp fxn.
69
Q

Ankylosing spondylitis (AS): features

A

Sacroiliitis: SI joint pain, may cause deep dull buttock pain
Enthesitis:
- Entheses inflammation: where tendon, lig + joint capsule attach to bone
- results in bony erosion + overgrowth
- Osteopenia –> osteoporosis + fusion/rigidity = inc fracture risk
- affects rib cage + decrease chest expansion
- Syndesmophytes –> Bony Spurs on 2 sides of joint causing fusion and rigidity

Synovitis:
- usually affects peripheral joints: shoulders, hips, knees, ankles

Heart, lungs, eyes, bowel… Inflammation and scaring

70
Q

Ankylosing Sondylitis:

- clinical criteria

A

1) LBP + stiffness >300: improves with exercise, worse with rest
2) AM stiffness:
3) Altered posture/ muscle imbalances: deformity/ instability
- HFP, Tsp kyphosis, flattening of anterior chest wall, protrusion of abdomen, flattening of lumbar lordosis, slight hip flexion
4) dec strength –> deconditioned
5) dec Lsp ROM in saggital + frontal planes –> flexed posture
6) Altered breathing mechanics –> dec chest expansion, dec vital capacity
7) fatigue due to disease process

71
Q

Ankylosing Spondylitis:

  • physical assessment:
  • Rx
A

Ax:

  • Smythe test
  • Modified schobers
Rx:
- DMARDS, NSAIDs, CS, Biologics
PT: 
- control/ dec inflammation
- P management
- reduce stiffness/ inc ROM
- posture 
- strength, endurance , cardio
72
Q

AS: outcome measures

A

BASFI: impact of disease on fxn in last week

BASDAI: how disease is managed

73
Q

Differentiate mechanical vs inflammatory back pain.

  • duration
  • age
  • pain
  • type
  • xray
A

Inflammatory:
- 12-40 y.o. Last >60 min, worse in AM, chronic, Xray = scroiliitis, syndesmophyte, spinal ankylosis.

Mechanical:
- 20-65 y.o. Lasting

74
Q

Juvenile idiopathic arthritis:

  • s/s
  • Ax
A

S/s:

  • pain, dec fxn, AM stiffness, dec ROM + strength + flexibility, growth abnormalities, asymmetrical posture + movement patterns,
  • eyes: uveitis
  • affects synovium, tendons sheath, entheses

Ax:
- Pain, ROM, joint count, mm strength and length, fatigue,

75
Q

Juvenile idiopathic arthritis:
Dx
Rx

A

Dx:
- s/s must be present for 6 months. Subtype determined by presentation in 1st 6months

Rx:
- get child as activate as possible.
- complete remission in 75% of kids under 16
Stages:
1) acute –> maintain ROM and fxn
2) subacute –> ROM And strength
3) chronic –> complex activities/ balance

76
Q

Exercises in RA and OA:

A

RA:
- affects MCP + PIP, rheumatoid cachexia (break down of mm fibres), fatigue
OA:
- affects weight bearing joints: hip, spine, stretching/ROM

Contraindications/ red flags:

  • inc pain, fatigue, AM stiffness
  • sudden pain at joint or joint deformity
  • joint becomes Red hot swollen after exercise (24hrs)
  • dec mm strength and lengh
  • Neurological s/s (cv involved)
  • SOB one mild exercise

Precautions:

  • innapropriate exercises, swollen joints at risk for capsular stretch
  • OP bone at risk of #
  • use machines and bands rather than free weights
77
Q

Insulin function

A

Regulates glucose levels

  • promotes glucose uptake into the cells for storage
  • -> mm, liver, adipose tissue
78
Q

Differentiate b/w type 1 and 2 diabetes

A

Type 1: insulin deficient

  • juvenile onset
  • requires insulin
  • immune mediate attach to islet cells in pancreas thereby reducing circulating insulin
  • Presentation:
  • ->weight loss, increase urination, dehydration

Type 2: Insulin resistant

  • adult onset
  • pt don’t require insulin, peripheral tissues do not respond to it.
  • Presentation:
  • -> Obese, HTN, hyper pigmented skin (acanthosis, nigrican)
79
Q

DM:

- Hypoglycaemia vs hyperglycaemia presentation

A

Hypo:
- dizzy, blurred vision, sweating profusely (r/o ortho static hypotension), fatigue, irritability, confusion, fainting

Hyperglycaemia:
- blurred vision, fatigue, thirst, urination, weakness, abnormal breathing, acetone breath

Long term effects:

  • damage to small blood vessels (retinopathy and diabetic nephropathy)
  • damage to large blood vessels via abnormal glucose metabolism causes increased cholesterol levels –> vessel wall damage –> atherosclerosis or MI, or Stroke, gangrene
  • damage to peripheral nerves, diabetic neuropathy
80
Q

DM:

  • normal glucose levels
  • Long term consequences
A
  • normal fasting plasma glucose: 5.6 - ulcers–> amputation
  • kidney: diabetic nephropathy–>CHF–> swelling –> HTN –> protein urea
  • eyes: diabetic retinopathy (blind)
  • heart: MI, stroke, atherosclerosis
  • infections
81
Q

DM:

- Rx

A

Diet +meds to stimulate insulin secretion

- exercise! But caution with night exercise cuz of diabetic coma from hypoglycaemia when sleeping

82
Q

Chronic pain signals fired via what fibres?

A
  • A Delta: high threshold, sharp, localized, fast adapting
  • -> meds work well
  • C Fibres: low threshold, dull aching, slow and persistent
  • -> meds do not work
83
Q

pain:

  • Pathology
  • conduction
A
Tissue damage (stimulates nociceptors), inflammatory mediators released cause swelling + inflammation. 
- release of cells in plasma (bradykinin, prostaglandins, sub p) stimulate pain receptors

Conduction via LST-tract to thalamus and to the cortex
- periaqueductal grey –> releases endorphins –> inhibits sub P + glutamate release to reduce pain

84
Q

Chronic pain: pathology

A
  • Actual chemical changes occur in the tissue and the limbic system of brain
  • receptors become hypersensitive –> allodynia or hyperalgesia cause increase actiivty in pain pathways

Rx:

  • have to desensitize the area
  • educate them that it’s not in their head
  • restore normal function to the area
  • -> medication, electro therapy, cryogenic/thermotherapy, exercise/ stretch can reduce pain caused by mm spasm
85
Q

Chronic fatigue syndrome:

  • Dx
  • Rx:
A

Dx: via exclusion

  • persistent or relapsing fatigue for >6months
  • not resolved with bed rest
  • reduces daily activity by 50%

Rx:

  • analgesic, anti-inflammatories, NSAIDs, nutrition, psych
  • exercise
86
Q

Fibromyalgia

  • defined
  • s/s
  • Rx
A
  • chronic pain syndrome of unknown ethology affecting mm + soft tissue (non- articular rheumatism)

S/s:

  • headache,sensitivity, fatigue,myalgia, aching, sleep disturbances, anxiety/depression
  • 11/18 points –> occiput, low cervical (c5-7), traps, supraspinatus, 2nd rib, lateral epicondyle, gluteal, greater T, knee

Rx:
- energy conservation + pool, anti-inflamm, pain meds, psych, nutrition, heat, dry needling

87
Q

Sepsis:

  • defined
  • septic shock
A

Presence of systemic inflammatory response syndrome + infection

Septic shock:

  • severe sepsis but hypoperfusion abnormalities in spite of adequate fluid resuscitation
  • immune system spirals out of control
  • ” normal response to infection is local but then causes widespread vasodilation and vascular permeability”
88
Q

Shock

  • defined
  • types
A

Poor distribution of blood at the microcirculation level = dec perfusion –> potential cell death

Types:

  • hypovolemic (blood loss)
  • cardiogenic ( heart damage)
  • distributive (hypotension and general tissue hypoxia)
  • obstructive (Great vessels of heart)
89
Q

SIRS = systemic inflammatory syndrome:

  • defined
  • Dx
A
  • whole body inflammatory state

Dx: via body temp, HR, RR, WBC count

  • HR >90
  • temp >38 o4 20 or PaCO2 12000 or
90
Q

Obesity:

- FITT

A

40-60% HRR, 5-7day/ week, 45-60min of. Circuits or aquatics

- caution to not over heat.

91
Q

Pregnancy:

  • posture changes
  • % of incontience
A
  • HFP
  • inc thoracic kyphosis
  • inc lumbar lordosis
  • breast size
  • shoulder protraction
  • dec form and force closure –> pelvic floor stretch
  • lig laxity
  • balance changes

Incontinence –> 67% from vaginal delivery

92
Q

Pregnancy:

- PT antepartum concerns

A
  • antepartum bleed
  • preterm labor (irritable uterus) : “mini contraction”
  • ruptured membrane: slow trickle of fluid (no water break)
  • incompetent cervix/ changes
93
Q

Diastasis Rectus abdominus:

  • defined
  • effects
  • Rx:
A
- lateral separation/ split of Rectus abdominus (>2.5 cm is sig, usually detected in 2nd trimester)
Effects:
- weak abdominal wall
- dec support for back and viscera
- related to lumbo-pelvic pain

Rx:

  • education, posture and mechanics, movement pattern and recruitment strategies
  • EXERCISE: TA, Multifidus, PF
  • abdominal binders
  • recovery 2-6 months, surgery if severe
94
Q

Varicose veins:

  • define
  • s/s
  • Rx:
A

Veins that are enlarged + twisted + poor valve closure,

S/s:
- heaviness, dull ache in legs with standings get and walking. Veins distension, tenderness, LE most common

Rx:
- posture, positioning in elevation, limit crossed legged time, pressure graded clothing, circulatory exercises.

95
Q

Pregnancy: incontinence

A
  • inc risk in vaginal delivery. Dec abdominal recruitment with inc intra abdominal pressure or strong need to urinate when on toilet.

Causes:

  • injury to CT, pelvic nerves and mm
  • injury to urinary tract, changes in PF anatomy
  • urethral weakness/ vaginal relaxation

Rx:

  • PF exercises (10sec hold, 10 contraction 2-3x/week) w/ fxn tasks
  • co-contraction of TA + PF
  • posture and body mechanics
  • urgency techniques (perch, PF contractions, walk to bathroom)
  • diet changes (less coffee etc)
96
Q

Gestational diabetes:

  • what to avoid during RX
  • Red flags for reproductive problems
A

Avoid:

  • valsalva/ exercises that stress PF + abdominals
  • rapid uncontrolled movements
  • positions of inversion
  • deep heating modalities
  • manual therapy?
  • positioning? Supine only short periods
  • **give posture tips and STS strategies using glutes

REDFLAGS:

  • changes in BnB fxn, sexual fxn,
  • non-mechanical lbp
  • suprapubic or groin pain
97
Q

PF disorders:

  • causes
  • types
  • s/s
  • PT Rx
A

Due to stretch–> ca lead to partial or total organ prolapse

  • Cytocele: herniation of bladder into vagina
  • Rectocele: herniation of rectum into vagina
  • Uterine prolapse: bulge of uterus into vagina

S/s:
- pelvic pain, urinary incontinence, pain with intercourse, heaviness in saddle region, incomplete emptying. Worse with activity or EDL of day

PT Rx:
- PF mm exercises, postural re-Ed, pessary, surgery

98
Q

Preeclampsia:

  • define
  • s/s
A
  • pregnant induced acute HTN after 24 weeks gestation

S/s:
- HTN, edema, headache, visual disturbances, hyper-reflexia

99
Q

C-section

- PT tx

A
  • TENS for incision pain
  • breathing exercises
  • gentle ab exercises
  • PF
  • posture, ambulation
  • scar massage
100
Q

Burns:

  • severity
  • rule of 9
A

1st: superficial, erythema
2nd: partial thickness, blistering appearance
3rd: full thickness, necrosis (skin falling off)

Rule of 9: to determine body surface area involvement (except 1st degree)

  • head = 9 (18)
  • torso = 36
  • arm = 9
  • leg = 18 (kids 14)
101
Q

Burns:

  • phases of wound healing
  • classification of wound healing
A

1) inflmamation (

102
Q

Burns:

  • zones
  • effects of body tissue
A

Zone of coagulation: point of max damage, irreversible tissue loss
Zone of stasis: dec tissue perfusion, maybe salvageable
Zone of hyperemia: inc profusion, we’ll recover unless sepsis occurs

Effects:

  • CVS: inc capillary permeability = interstate edema. Peripheral vasoconstriction, hypovolemia, myocardial depression, dec CO
  • Resp: bronchoconstriction, ARDS, Carson monoxide (low O2 cc)
  • metabolism: increase 3x’s
  • immune system: compromised
  • Renal: loss of fluid –> vasoconstriction, dec GFR, inc myoglobin gets processed by kidneys and can block tubules.
103
Q

Burns:

  • signs of inhalation injury
  • Rx
A

S/s:
- singed eyebrows/ face, swollen lips, hoarse voice, poor SpO2
- w/in 24hrs–> upper airway obstruction/ pulmonary edema
- 24-48: pulmonary edema, 48+ bronchiolitis, alveoli this, pneumonia, ARDS
Tx: mobilize, breathing ex, postural drainage

PT Rx:
- keep wound moist, HVPC, good health/diet, de bride wounds, ROM, positioning, edema management. Scar management (1-4 days) for scar tissue contracture.

104
Q

Conditions that are contraindicated to exercise:

A
  • exposed joint, fresh skin graft, DVT, compartment syndrome
105
Q

Skin graft:

  • types
  • Rx:
A

Split thickness skin graft:
- stiches, glue, suture, immobile for 5 days
Full thickness:
- skin transplant

Rx:

  • scar massage, sun protection, ROM, pressure garments
  • strengthing in 3-4 weeks
106
Q

Scar from burns stages

A

0-4 weeks: fibroblastic/proliferative
4-12 weeks: early remodelling
12-40 weeks: late remodelling/maturation

-age, smoking, type of tissue, nutrition influence scar

Rx: pressure garment, massage, moisture

107
Q

4 stages of wounds:

A

1) reddened
2) skin is broken, small crater
3) deep crater, ?infection, ? Black from necrosis
4) deep through mm to the bone or joint

Describe:
- location, size, wound base, edges, surrounding skin, stage photo

108
Q

Wounds:

  • education for clients
  • Rx:
A
  • Look at skin 2x/day,
  • monitor temp, colour, text, erythema, discolouration
  • Braden scale of ax risk

Rx:

  • multidisciplinary team, dressings, mobility restrictions
  • PT: HVPC level 1 evidence for wound healing
109
Q

Psoriasis:

  • definition
  • Cardinal signs
A

Autoimmune disease that affects the skin
- faulty signals that speed up the growth cycle of skin cells causing profound cutaneous inflammation and epidermal hyperplasia.

5 signs:

  • plaque (raised lesion)
  • well circumscribed margins
  • bright salmon red
  • silvery micaceous scale
  • Symmetrical distribution
110
Q

Psoriasis:

  • complications:
  • Rx
A
  • physical (Pruitis,bleeding of lesion
  • emotional and psychological (isolation, loss of self esteem)
  • economic: cost of meds, time away from work
  • severe psoriasis is associated with CVD, and arthritis

Rx:

  • Topical creams containing glucocorticoids
  • Tars
  • Vitamin D or A
  • Phototherapy with UV light
  • Systemic therapy with immunosuppressive drug
111
Q

Eczema:

  • define
  • features
  • types
A

Dermatitis/inflammation of the epidermis
- itchy, red scaly disorder

Types: Atopic dermatitis (endogenous) or contact dermatitis

112
Q

Atopic Dermatitis:

  • defined
  • presentation
  • phases
  • Rx
A

Itchy inflammatory disorder associated with atopy in people predisposed to certain allergic hypersentivity.

  • Itchy (Pruitis), linchenification (thickened skin lines), excoriation (scratching), crusting

Phases:

1) infantile: facial and extensor distribution
2) Childhood: dry skin, flexural distribution (knee/ elbow creases)
3) adult: improves with age, primarily affects the hands

Rx:
- avoid irritants, UV therapy, moisturizers, topical glucocorticoids, antihistamines,

113
Q

Contact dermatitis:

  • types + features
  • Rx
A

Allergic contact dermatitis:
- immune hypersentivity to an allergen in contact with skin (nickel, poison ivy)

Irritant contact dermatitis:
- contact causing direct local irritation (harsh detergents, chemicals)

Rx: topical steroids

114
Q

Seborrheic dermatitis:

  • what is it?
  • where?
  • features
  • Rx
A

“Dandruff”
- occurs in high oily areas (high sebaceous gland activity) due to an excessive immune response to yeast

  • ill defined areas of erythema with greasy appearing scale

Seen in: PD, Stoke, TBI, SCI, HIV (with low mobility)

Rx: antifungals

115
Q

Liver:

  • main 3 functions
  • s/s of illness
A

Producing:

  • albumin (fluid transmission)
  • Clotting factors (bleeding)
  • Ammonia metabolism (breaks down protein by-product –>urea–>excreted by kidneys

S/s: yellow, itching (Pruitis), big belly (ascites), bleeding, esophageal varices

116
Q

Hepatitis A:

  • transmission
  • risk factors
  • s/s
A
  • virus transmitted by fecal oral route

Risk factors: international travel, daycare
- vaccine is available

S/s: jaundice, fatigue, weakness, anorexia, nausea, vomiting, abdominal pain

Note: kids are usually asymptomatic

117
Q

Hepatitis B:

  • transmission
  • risk factors
  • complications
  • Rx
A

Infection of liver, can become chronic and lead to cirrhosis and hepatocellular carcinoma.

  • high risk in 3rd world countries
  • high risk of spread mother to child, less so via sex/ drugs

Rx: antiviral, vaccine, no cure

118
Q

Hepatitis C:

  • transmission
  • complication
  • Rx:
A

Transmission:

  • percutaneously (needles and drugs)
  • non percutaneously (sex)
  • hemodialysis
  • high risk of chronic complications (more than hep B)
    Rx: interferon and anti-viral agents
119
Q

Grave’s disease:

  • pathology
  • s/s
  • Rx:
A

“Hyperthyroidism” F>M
- autoantibodies stimulate the thyroid (TSH receptor), T3, T4 to inhibit the secretion of TSH.

S/s: goiter, bulging eyes, fever, weight loss, exercise intolerance, tachycardia,

Rx:
- beta blockers for HR, anti-thyroid drug therapy, radioactive idione, Sx removal thyroid.

120
Q

Hashimoto Thyroiditis: hypothyroidism

A

“Hypothyroid”, F>M
- autoimmune destruction of thyroid gland, T3, T4 low, TSH high

S/s:
- wt gain, cold tolerence, round puffy face, bradycardia, constipation, depression

Rx: thyroid hormone replacement

121
Q

Addison’s disease:

  • define
  • s/s
  • Rx
A

Autoimmune process against the adrenal cortex, fatal if not treat, good prognosis if treated.

S/s: weakness, fatigue, anorexia, hyponatremia, hypoglycaemia, hypopigmentation

Rx:
- replace missing adrenal hormone with aldosterone and cortisol

122
Q

Cushing’s disease:

  • define
  • s/s
  • Rx
A

Chronic glucocorticoid (cortisol) excess

S/s: moon face, central obesity, abdominal striation

Rx:
- surgical if caused by tumor (pituitary or adrenal gland)

123
Q

Two types of inflammatory bowel diseases

  • complications
  • S/s
  • Rx:
A
  • Crohns: gum to bum
  • Ulcerative colitis: colon and rectum

Affects the entire GI tract: gum to bum

  • ulcers, fissures, fistulas, you get alterations in digestion and absorption = malnutrition
  • s/s:
  • Abdominal pain and cramping
  • Diarrhea
  • Weight loss (unable to absorb nutrients)
  • Nausea & vomiting
  • Blood in stool
  • Fever
  • Fatigue

Rx:
- anti-inflammatory drugs for bowel, prednisone (immunosuppressant), antibiotics

124
Q

Main concern from a transplant?

A
  • donor factor (disease?)
  • coagulation products at time of transplant (will they bleed out?)
  • function, immuno suppression, rejection, infection
125
Q

Lung tumor quick facts: spread, origin, met?

  • small cell
  • squamous (non small cell)
  • adenocarcinoma
  • large cell
A

Small cell:
- 25 % develop into bronchial cell mucosa, rapid spread, met early
Squamous:
- slow spread, arise in central portion near hilum, met late
Adenocarcinoma:
- 40%, slow-mod spread, early mets through lung/brain/other organ
Large cell:
- rapid wide spread mets, kidney, liver, etc, poor prog

126
Q

Connective tissue tumors: quick facts

  • osteosarcoma
  • synovial sarcoma
  • Osteoid osteoma
  • prostate
A

Osteosarcoma: end of long bones, moth eaten appearance, can occur in youth

  • synovial sarcoma: larger joints, swelling + instability, surgery +/- chemo/radiation, ?met to bone. Origin: breast, lung, prostate, thyroid
  • Osteoid osteoma: Benign tumor, exercise related bone pain and tenderness, abolition of symtoms with ASA, Tx = ablation, ethanol, laser
  • Prostate: men >50, tx = surgery, laser, androgen deprivation
127
Q

Brain tumors: quickly

  • intra cerebral metastic
  • intra spinal
  • low grade astrocytoma
  • medulloblastoma
  • neuromas
A
  • intra cerebral metastatic: from lungs/breast/prostate. Compensate by dec brain tissue/ CSF, blood flow volume
  • Intraspinal: nerve root pain, worse at night, cough, radicular pain,
  • low grade astrocytoma: benign, good survival with early tx
  • medulloblastoma: frequent meds to other areas of brain and spine
  • neuromas: schwannoma –> CN 8, headache, seizures, vomit, cognition
128
Q

Skin tumors: quick

  • Basal cell carcinoma
  • Squamous cell
  • malignant
A
  • BCC: most common, low risk of spread, translucent and red in color
  • Squamous cell: solid skin color, volcano shaped, high risk of mets
  • malignant melanoma: most dangerous, high risk of mets