30. System Interactions

Question 1

what is sarcoidosis

Answer 1

systemic disease of unknown cause

triggering agent may be genetic infections immunologic or toxic

characterized by granulomatous inflammation in nodular form

F>M 20-40

small patches of swollen tissues - skin, lymphatic, lung, liver, spleen

scarring of tissue

RLD

Question 2

sarcoidosis symptoms

Answer 2

dyspnea, cough, fever, malaise, weight loss, skin lesions, erythema nodosum, dry cough, chest pain, hemoptysis, pheumothorax

muscle weakness, aches, tenderness, and fatigue that reduces functional capacity

Question 3

criteria for diagnosis of RA

Answer 3

morning stiffness for at least 1 hours

arthritis of 3 or more joint areas

symmetric arthritis
arthritis of hand joints
rheumatoid nodules (over bony prominences or extensor surfaces)
serum rheumatoid factor
radiographic changes (periarticular osteopenia)

Question 4

EDS

Answer 4

It is a group of hereditary connective tissue disorder

Cutaneous manifestations are hallmark signs:
* Skin hyperextensibility, smooth and velvet-like texture,
fragility, delayed wound healing, and thin atrophic scars after
wound healing

Systemic involvement:

MSK: Joint hypermobility, joint laxity leading to dislocations/
subluxations, osteoporosis, early onset OA, scoliosis, kyphosis

Neuromuscular: Generalized muscle weakness, low muscle tone

Cardiopulmonary: Autonomic dysfunction resulting in abnormal
chest pain, palpitations, abnormal blood pressure responses

Hematologic: Easy bruising, prolonged bleeding times

Question 5

The patient reports severe stiffness in the hands especially the distal
interphalangeal joints, knees, elbows and toes that tends to last for at least 45
minutes every morning then improves with movement. During assessment, the
therapist also notices diffuse swelling of the fingers and brownish-yellow
discoloration of the nails. What is the MOST LIKELY cause of these symptoms?

A. Ehlers-Danlos syndrome
B. Rheumatoid arthritis
C. Psoriatic arthritis
D. Reiter’s syndrome

Question 6

A patient presents to an outpatient clinic with reports of knee
pain and the clinician suspects a ligament involvement. Which of
the following is the MOST APPROPRIATE diagnostic test to
confirm these findings?

A. Anterior drawer test
B. Radiography (X-Ray)
C. Magnetic Resonance Imaging (MRI)
D. Computed Tomography (CT) scan

Question 7

nerve conduction velocity

Answer 7

is a technique for evaluating both the
speed as well as the amplitude of the electrical signal evoked following
stimulation of a sensory or a motor nerve. NCV detects a problem with the
nerve.

Question 8

electromyography

Answer 8

is a technique for evaluating and recording
electrical activity of muscles at rest and while contracting. EMG detects
whether the muscle is working properly in response to the nerve stimulus.
It assists with diagnosis of nerve or muscle pathology.

Question 9

Motor NCV

Answer 9

It represents the conduction of an impulse
along peripheral motor nerve fibers

It measures the time it takes for electrical
impulse to travel from the stimulation to
the recording site called latency (ms) and
size of response called amplitude (mv)

Potential is recorded from a distal muscle
innervated by the nerve
Ulnar – Abductor digiti minimi
Median – Abductor pollicis brevis
Peroneal – Extensor digitorum brevis
Tibial – Abductor hallucis or digiti minimi

Question 10

sensory NCV

Answer 10

It represents the conduction of an impulse
along the sensory nerve fibers

It measures latency and amplitude.
Amplitude is smaller than motor NCV

Potential is recorded from a purely sensory
portion of the nerve, such as on a finger
Median – Index and thumb
Ulnar – Little and ring
Sural – Behind the lateral malleolus
Saphenous – Anterior to medial malleolus

Question 11

EMG signals

Answer 11

EMG signals are captured using a needle electrode, which is
inserted into the muscle through the skin
* Insertional activity – Lasts less than 300 ms
* Electrical silence at rest
* Contract the muscle minimally – Normal motor unit potential
* Contract the muscle maximally – Interference pattern

Question 12

spontaneous potentials

Answer 12

Spontaneous potentials: Seen at rest
* Fibrillation potentials
* Fasciculations
* Positive sharp waves
* Complex repetitive discharges
* Myotonic repetitive discharges

Question 13

polyphasic potentials

Answer 13

Seen with contraction
- More than 4 phases

Question 14

A patient presents with loss of sensation on the anterior leg and
weakness of dorsiflexors after sustaining a fracture of the proximal
fibula. Which of the following findings is MOST LIKELY to be seen
with electrodiagnostic testing?

A. Increased motor NCV of the peroneal nerve
B. Decreased latency of the peroneal nerve
C. Fibrillation potentials seen at rest during EMG testing of tibialis
anterior
D. Electrical silence seen at rest during EMG testing

Question 15

A patient underwent a total knee replacement surgery last week
and is on anticoagulant therapy. Which of the following
medications should be AVOIDED by the patient?

A. Diphenhydramine (Benadryl) to avoid risk of ecchymosis
B. Methotrexate (Trexall) to avoid risk of hypotension
C. Atenolol (Tenormin) to avoid risk of hypotension
D. Acetylsalicylic acid (Aspirin) to avoid risk of ecchymosis

Question 16

Warfarin (COUMADIN) side effects and desired effects

Answer 16

Used as anti clotting drug for
myocardial infarction (MI),
Emboli, Stroke, prevent venous
thrombosis

Increased risk of hemorrhage
can lead to lightheadedness
due to bleeding.

Question 17

ASPIRIN desired effects and side effects

Answer 17

Antiplatelet function used to
prevent Coronary Artery
Disease (CAD), MI

Not to be used in acute injury
as it will prevent clotting of
blood.

Question 18

A physical therapist is evaluating a patient with a traumatic brain
injury and suspects delirium. Which of the following signs would
confirm the physical therapist’s suspicion?

A. Gradual onset of forgetfulness as reported by family members
B. Acute onset of confusion and hallucinations
C. Disorientation and confusion that occurs consistently in the
evening (sundowning)
D. Mask-like face and tremors

Question 19

dementia

Answer 19

gradual decline of cognitive functioning

Typically, symptoms become apparent after age 60
*Decreased functional capabilities
* Poor education carryover
*Impaired activities of daily living

Dementia can involve multiple parts of the brain
* Emotional changes
*Decreased motivation
* Speaking/processing difficulties

Question 20

symptoms of dementia

Answer 20

*Impaired higher-level functions like language, perception
* Personality changes
* Memory deficits
*Deterioration of judgement, orientation
* Confusion
*Normal consciousness

Question 21

Which of the following change is MOST LIKELY to be seen with
aging?

A. Increased BP
B. Increased skin elasticity
C. Increased muscle tone
D. Increased sweat production

Question 22

A patient presents to a physical therapy clinic with agonizing,
nauseating, exhausting, tiring and unbearable pain. What pain
pattern is MOST RELATED to the symptoms?

A. Vascular
B. Neurogenic
C. Musculoskeletal
D. Emotional

Question 23

A patient with chronic pain reports fatigue and decreased range
of motion, which worsens with stress. Upon examination, the
physical therapist finds multiple tender points but no referred
pattern of pain or no muscle tightness. What is the MOST LIKELY
diagnosis?

A. Lumbar radiculopathy
B. Myofascial pain syndrome
C. Fibromyalgia
D. Osteoarthritis

Question 24

cryoglobulinemia

Answer 24

protein clumps together and forms blood clot that restricts flow to organs

Question 25

impetigo

Answer 25

small pus filled vesicles that dry out and become yellowish - honey crust appearance - typically around mouth children and elderly due to immunocompromised a bacterial infection caused by strep or staph

Question 26

vasculitis

Answer 26

inflammation of blood vessels - may cause ischemia, redness, rashes

Question 27

dermatitis (eczema)

Answer 27

causes: allergic or contact acute - red oozing crusting rash, exudate, erosions, subacute - erythematous skin, scaling scattered plaques chronic - thickened skin fibrotic papule and nodules tx - corticosteroids, antihistamines, immunosuppresents