Pathology Terms Flashcards

Question

Nerve vs Tract

Answer 1

Nerve is in the periphery while a tract is central

Answer 2

To become aware of pain, noxious stimuli must travel from the dorsal horn of the spinal cord to the brain 2 Tracts responsible for this transmission:  Spinothalamic [fast pain] – spinal cord to the thalamus  Thalamus acts a general relay station sending stimuli to the somatosensory cortex where sharp, discriminative and localized sensations are perceived  Spinoreticulothalamic [reticular pain] – spinal cord to the reticular formation of the brainstem to the thalamus

Answer 3

Modulates pain ◦ Not completely understood ◦ Evidence shows our body produces natural endogenous opiates to inhibit perception of pain ◦ Ex: serotonin, dopamine ◦ Release of the opiates is stimulated by pain, intense exercise, laughter, relaxation, meditation, acupuncture, and electrical stimulation

Answer 4

- Can be psychologically based - Result of a general medical condition - Chronic post op pain  i.e. phantom limb pain Medical Management ◦ Caring for the whole person  Identifying the mechanism for pain  Pain perception  Psychological impact

Answer 5

◦ Counterproductive to speculate whether the pain is real or not ◦ Creating and working within mutually accepted goals ◦ Focus on improving functional outcomes (rather than pain) ◦ Dealing with chronic anxiety & depression in the patient ◦ Monitor for fear avoidance behavior  Pt. education: pain does not equal new injury

Answer 6

Means porous bones - Systemic condition and metabolic disease involving diffuse loss of bone density and strength ' Combination of decreased bone mass and micro damage to the bone structure that results in a susceptibility to fracture - Bone reabsorption exceeds bone formation - Declined osteoblast function

Answer 7

 Non-modifiable ◦ Female  Post-menopause ◦ Age > 50 ◦ Caucasian/Asian ◦ Thin, small-frame (less cortical bone) ◦ Family history/genetics

Answer 8

Modifiable: ◦ Sedentary lifestyle ◦ Diet and nutrition ◦ Low calcium intake ◦ Smoking ◦ Excessive alcohol intake (> 2 drinks / day) ◦ Excessive caffeine intake (equivalent to > 3 cups of caffeinated coffee) ◦ Excessive tobacco use ◦ Certain medications (Ex. Corticosteroids) Low Body weight and BMI

Answer 9

Loss of height, postural changes, back pain and fracture*  Marked thoracic spine kyphosis and “dowager’s hump”  Fractures, commonly in the wrist, hip, vertebral compression factures  Low back and neck pain

Answer 10

Fracture of the anterior portion of a vertebrae (commonly seen in people with osteoporosis)

Answer 11

History: vitamin, calcium intake, use of corticosteroids Bone mineral density testing (BMD) Imaging studies ◦ DXA: dual energy x-ray absorptiometry - (-1.0 or higher is normal, -2.5 or lower is osteoporosis) Radiograph: to diagnose fractures

Answer 12

 Prevention is best*  Calcium, magnesium and vitamin D supplements  Regular exercise: aerobic and resistance training provide weight- bearing to bone  Lifestyle changes to decrease risk factors ◦ Minimize caffeine, alcohol, tobacco, adequate nutrition

Answer 13

Pt. Education - Spinal extension exercises - Heat, massage, spinal support to reduce pain Contraindications - include spinal flexion exercises, mobilization techniques, traction

Answer 14

Greenstick: an incomplete bone fracture where the bone bends and cracks on one side but does not break completely through Spiral: a broken bone that occurs when a bone is twisted, causing the break to coil around it like a corkscrew Comminuted: a break where the bone shatters into multiple pieces Transverse: a bone break that occurs at a right angle, or horizontally, across the long axis of the bone Compound: a broken bone that pierces the skin, creating an open wound Compression: a break in a spinal vertebra (bone) that causes the bone to collapse or compress

Answer 15

Colles' Fracture: a break in the large forearm bone (radius) near the wrist Boxer's Fracture: a break in the neck of one of the five metacarpal bones in the hand, most commonly the fifth metacarpal near the pinky finger. It is often caused by punching something with a closed fist FOOSH (Fall On Outs Stretched Hand): an injury that occurs when a person falls onto an outstretched hand, causing a break in the bones of the wrist, elbow, or arm Skaters or Snow Border's: in the feet, ankles, or lower legs, due to repetitive impact and landings Avulsion: a bone break where a small piece of bone is pulled away from its main body by a tendon or ligament

Answer 16

[not needed for this class] a genetic disorder present from birth where bones are improperly formed due to a defect in collagen

Answer 17

a surgical procedure used to treat bone fractures. During an ORIF, the surgeon makes an incision to realign the broken bones (open reduction) and then uses hardware like screws, plates, or rods to hold them in place (internal fixation).

Answer 18

◦ 3-4 days- Fractured edges become necrotic. Osteoblasts mobilize in the area (inflammatory phase). ◦ Approx. up to 2 weeks: Osteoblasts form soft callus (reparative phase). ◦ 3-4wks- Hard callus develops. ◦ 3-4 months to years: Fracture is healed, but bone continues to remodel

Answer 19

Following a fracture there is usually a period of immobilization ◦ Blood clot prevention ◦ Promoting fracture repair  Avoiding substances like nicotine that inhibit fx repair ◦ Monitor for neurovascular and integumentary changes during this period  Compartment syndrome

Answer 20

Early Mobilization ◦ Transfer training ◦ Strength training ◦ ROM  Reduces risk of DVT/PE, skin breakdown, pneumonia and decline in mental status  Decrease in LOS  Quicker discharge home

Answer 21

 May heal in a bad position: Mal-union  May take longer than usual: Delayed union  Failure to heal: Non-union  Loss of blood supply to area will limit healing (Avascular necrosis)  Emboli (Clot, Plaque, air, etc.)

Answer 22

- Infection may develop in bone if open fracture or external fixation. Look for signs of osteomyelitis and report  Unusual redness, increased pain, swelling, drainage from a external fixator pin site.

Answer 23

Ca+ out of bones

Answer 24

Degenerative Joint Disease (DJD), degenerative arthritis, osteoarthrosis, OA  Breakdown of hyaline cartilage [covers ends of bones] [articular cartilage is a subtype of hyaline cartilage]  Non-inflammatory, slow, progressive damage and loss of articular cartilage  Joint spaces narrow, eventually produces bony remodeling and overgrowth (spurs)  Affects weight-bearing joints; most commonly hips, knees, shoulder, cervical, lumbar spine, hands  Primary – unknown cause, defect in articular cartilage  Secondary – known cause, trauma, infection, hemarthrosis, osteonecrosis  Most common joint disease ◦ 60% of men, 70% of women after age 65 yrs ◦ Approx. 40 million people in U.S.  Most common indication for total joint replacements

Answer 25

 Loss of articular cartilage: leads to inflammation, bony overgrowth, ligament laxity, progressive muscle weakness and atrophy  Cartilage becomes thin and soft, begins to flake off and enter joint cavity  Damaged tissues stimulate enzymes that accelerate the degenerative process  Surface defects appear and expose underlying bone, which then becomes sclerotic  Joint space narrows

Answer 26

 *Bony enlargement, limited ROM, crepitus on motion, tenderness on pressure, joint effusion, malalignment, joint deformity  Pain on weight bearing  Stiffness after inactivity (sitting, sleeping) ◦ Morning stiffness of 5-10 minutes  Muscle atrophy, weakness, and spasm  Reduced or loss of function  Inflammation, edema with acute exacerbations  Slow and gradual progression of pain - Joints may enlarge and present with nodes. ◦ Buochard nodes on proximal IP joints ◦ Heberden nodes on distal IP joints

Answer 27

 Medications: NSAIDS  Supplements: Glucosamine  Injections of Corticosteroids and medications based on hyaluronic acid  Joint aspiration to remove fluid  Bracing  Dietary changes-weight loss and exercise  Joint replacement surgery  Education

Answer 28

 Prevention: Healthy lifestyle -> exercise, weight reduction  Improve functional status  Reduce pain, muscle spasms  Modalities  Maintain/improve ROM, flexibility, strengthening, aerobic conditioning ◦ Consider aquatic exercise and less loaded activities (low-impact)  Patient education (about disease, safe exercises)  Assistive devices as needed

Answer 29

 Removal of bone spurs (Resection)  Transplantation of new cartilage  Autologous Chrondrocyte Implantation (ACI) [Cartilage from oneself grown in a petri dish and put back into the body where needed]  Osteochondral Autograft Transplantation (OATs) [a surgical technique to repair damaged joint cartilage and underlying bone by taking plugs of healthy tissue (cartilage + bone) from a non-weight-bearing area of the patient's joint and transplanting them into a defect site]  THA (THR)  TKA (TKR)

Answer 30

 Observation of Precautions  **Posterolateral Hip Replacement: NO flexion > 90, IR, or adduction  Exercise to restore strength and function, functional training.  TKA require techniques to improve range of motion

Answer 31

 Chronic systemic inflammatory disease with articular and non-articular findings  Chronic polyarthritis  Affects many systems (MSK, CVP, GI)  Unsure of exact cause  Autoimmune disease  Connective tissue (cartilage, adipose, osseous tissue, etc. blood) disease

Answer 32

◦ Genetic predisposition and environmental triggers ◦ Women>Men ◦ Age (25-50 yrs)

Answer 33

Clinical Manifestations  Symptoms begin insidiously and progress slowly  Systemic manifestations: ◦ Morning stiffness, symmetrical, B/L joint involvement, joint swelling, rheumatoid nodules  Articular symptoms  Other complaints: ◦ Weight loss ◦ Fatigue ◦ Diffuse musculoskeletal pain ◦ Weakness  Course can vary considerably  Joints ◦ Multiple joints involved bilaterally ◦ Warm, swollen, painful, stiff ◦ After rest periods, stiff lasting > 30 minutes  Soft tissue ◦ Synovitis (of the synovial membrane), bursitis, tendonitis, neuritis, etc.  Spine ◦ Early involvement of cervical spine ◦ subluxation

Answer 34

Hand deformities are associated with ulnar drift Swan neck deformities and Boutonniere deformities Swan Neck Deformity: a deformity of the finger characterized by hyperextension of the proximal interphalangeal joint (PIP) and flexion of the distal interphalangeal joint (DIP). Boutonniere Deformity: a deformity of the fingers in which the proximal interphalangeal joint (PIP) is flexed and the distal interphalangeal joint (DIP) is hyperextended. Pathology: Body believes synovial tissue to be foreign and attacks it, causing inflammation and joint effusion (swelling). This distends the joint. Enzymes cause breakdown of joint tissues)

Answer 35

 Early treatment is vital to long term outcomes  Lab testing: elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)  Mainstay of treatment is PT and drug therapy  Treatment goals: ◦ Reduce pain ◦ Maintain mobility ◦ Minimize edema, stiffness, and joint destruction - Can also use STRONG isometric to not only prevent atrophy but to also reduce pain by STRENGTHENING the muscles.  Pharmacotherapy ◦ Analgesics ◦ NSAIDs: long term use can cause stomach/GI issues. ◦ Corticosteroids: ◦ Note: Corticosteroids can cause delayed wound healing and osteoporosis ◦ Anti Rheumatic Drugs (DMARDs) ◦ Biologic Response Modifiers (BRMs) ◦ Immunosuppressants (methotrexate)

Answer 36

Represents a genetic heterogeneous group of metabolic disorders  Elevated level of serum uric acid (hyperuricemia)  Uric acid changes into crystals and deposits in peripheral joints (knee and great toe)  Predominantly viewed as form of arthritis

Answer 37

 Middle aged men  Family history  Heavy alcohol consumption  Obesity  Fasting  Medications  Renal insufficiency  HTN  Hypothyroidism  Diet: rich in purines (shellfish, trout, sardines, meat, asparagus, beans, peas, spinach)

Answer 38

 *Swollen, hot joint is always of concern  Need to distinguish between gout and septic joint as a septic joint is an orthopedic emergency  During acute attack: rest, elevation, protection of involved joint

Answer 39

 Goals: ◦ End acute attacks and prevent recurrent attacks ◦ Correct the hyperuricemia  Pharmacotherapy ◦ NSAIDS ◦ Corticosteroids (occasionally intraarticular injections) ◦ Meds to lower the concentration of uric acid (colchicine [kowl-chuh-seen])  Dietary changes, weight loss and monitor ETOH intake

Answer 40

 Disease occurs in 4 stages  Most common s/s: acute, monoarticular, inflammatory arthritis manifested by exquisite joint pain, occurring suddenly at night  1st MTP common site; ◦ Other sites: ankle, instep, knee, wrist, elbow

Answer 41

 Allopurinol ◦ Slows rate at which body makes uric acid  Colchicine ◦ Given during acute phase, less common 2’ narrow therapeutic range, many side effects

Answer 42

 Also called Marie-Strumpell disease; one of several inflammatory arthropathy of the axial skeleton  Progressive inflammatory arthritis leading to calcification and fusion (ankylosis) of the joints of the spine, sacroiliac joint  Men 2-3x more than women; 15 – 30 years of age; Caucasian and Native American populations  Approx. 2 million people in US

Answer 43

 Autoimmune  Genetic component  Seronegative for rheumatoid factor (It's NOT RA)  Clinical manifestations, radiographic findings, MRI to identify sacroiliitis ◦ Bamboo spine ◦ Dagger sign

Answer 44

 Insidious (proceeding in gradual, subtle way - negative way) onset of low back, buttock, hip pain, > 3 months  Tenderness over spinous processes and sacroiliac areas  Ankylosis – fusion or stiffening of the joints; mainly spine and sacroiliac joint, can also be shoulders, hips, knees  “Bamboo spine” - affected joints become fibrosed and calcified, intervertebral discs replaced with bony material, spine loses mobility and appearance of bamboo ◦ Inflammation in synovial joints of spine, enthesitis  "Dagger Sign" - A bright, white (radio-dense) line running vertically down the center of the vertebrae on a frontal X-ray. It's formed by bone building up in the ligaments connecting the back of the vertebrae.  Early stages: ◦ Fatigue, back pain, stiffness, sciatic nerve pain ◦ Symptoms greater in morning; alleviated with movement  As disease progresses: ◦ Lumbar curve lessens, thoracic curve becomes pronounced ◦ Head and neck move forward, hips flexed backwards ◦ Ribcage expansion affected if costovertebral joints are ankylosed

Answer 45

 Goal: reduce inflammation and stiffness  Maintain mobility, proper posture, exercise  Medications to reduce pain and inflammation ◦ NSAIDs, analgesics, muscle relaxants ◦ DMARDS  Surgery - rarely

Answer 46

Ankylosing - fusion [Ankylosaursus - "Fused Lizard" or "Stiff Lizard"]  Maintain mobility of the spine, especially into extension, proximal peripheral joints ◦ Flexibility exercises  Modalities and postural training may be used for pain relief.  Aerobic exercise, stretching, pulmonary exercises ◦ Chest expansion exercises ◦ Balance  Aquatic therapy; emphasize extension  AVOID ◦ High-impact activities; contact sports, high-risk activities ◦ Flexion activities

Answer 47

Description ◦ ‘pain in the muscles’ ◦ Chronic and systemic; associated with giant cell arteritis ◦ Diffuse pain and stiffness; neck, low back, shoulders and legs, proximal joints of shoulder and pelvic girdles Etiology (Not necessary to know) ◦ Unknown ◦ Possible genetic ◦ Possible environmental factors  Virus?

Answer 48

Signs and Symptoms (No need to know at this time)  Treatment ◦ *Medications to reduce pain and blood clotting

Answer 49

Focused on improving functional activity, reducing pain and stiffness, light to moderate aerobic conditioning, and tissue mobilization with exercises and modalities as well as possibly evaluating the patient’s home or work situation.

Answer 50

 Chronic, inflammatory, autoimmune disease, affecting multiple organ systems ◦ skin, bones, joints, NS, kidneys, lungs, blood, blood vessels, other organs  Remissions and exacerbations  Sudden or delayed onset  Women > men (10:1)  Different forms: ◦ *Systemic Lupus – most common* ◦ Discoid Lupus – affects only the skin ◦ Drug-induced Lupus – triggered by medications

Answer 51

 Unknown, cause; immunologic, environmental, hormonal, genetic factors  Autoimmune response that leads to production of circulating autoantibodies ◦ Production of antibodies against its own cells (tissue components)  React to DNA, RNA, nuclear proteins  Deposit immune complexes in connective tissue  Produces inflammation and tissue damage

Answer 52

 Musculoskeletal system ◦ Arthralgias, arthritis ◦ Fever, weight loss, malaise, fatigue  Cutaneous ◦ Facial rash (butterfly rash / malar rash), rash on sun-exposed areas, vasculitis  Cardiopulmonary system ◦ Pleuritis, pericarditis, dyspnea

Answer 53

 No cure  Mild cases ◦ Anti-inflammatory medications  Severe cases ◦ Corticosteroids and immunosuppressants ◦ Avoid aggravating factors  Observe for side effects of corticosteroids(edema, weight gain, bruising) long-term use-> osteoporosis, myopathy, tendon rupture, diabetes

Answer 54

 Skin care, prevention of skin breakdown  Generalized fatigue – activity pacing, energy conservation  Follow a prescriptive exercise plan (muscle strengthening, endurance), avoid excessive bed rest, protect joints  Treatment frequently includes posture reeducation, strengthening, and ROM and stretching.

Answer 55

Degenerative change in the spine = Osteoarthritis of the spine ◦ Commonly affects the neck ◦ Result in bone spur growths that can put pressure on spinal nerves or the spinal cord Etiology ◦ Aging process  Laxity in spinal ligaments, herniated discs ◦ Previous spinal injury ◦ Faulty Posture

Answer 56

 Pain: may be referred  Pain with movement  Pain in sacroiliac region, buttocks, and hips  Muscle spasms  Altered sensation and paresthesias  Limited range of motion/hypomobility  Osteophyte formation

Answer 57

 Analgesics, anti-inflammatories  Decompressive surgery  Cortisone injections Physical Therapy Intervention  Restore function through postural re- education and exercises  Reduce pain with use of heat, massage, relaxation exercises  Modalities  Patient education

Answer 58

◦ Structural deformity in the pars interarticularis of lumbar spine vertebrae ◦ Usually occurs at L4/L5 or L5/S1 ◦ Incidence is 3-7% of the U.S. population, increases with athletes in contact sports or gymnastics ◦ CAN CAUSE anterior slipping of the L5 vertebra over the sacrum called spondylolisthesis (Grade 1 – 4)

Answer 59

◦ May be clinically absent ◦ Discovered on radiograph

Answer 60

Etiology ◦ Cause unknown ◦ Repeated microtrauma from gymnastics, weight lifting, football ◦ Genetic defect ◦ Spina bifida occulta

Answer 61

◦ Analgesics ◦ Spinal fusion ◦ No extension exercises ◦ Dynamic stabilization exercises of trunk/spinal stabilization, abdominal strengthening

Answer 62

Description ◦ Vertebra becomes anteriorly disPLACED ◦ Usually affects L4/L5 or L5/S1 ◦ Age of onset usually > 40, women > men (3:1)  Etiology ◦ Disc degeneration and bone disease (arthritis) ◦ Birth defect or trauma to vertebral column

Answer 63

Signs and Symptoms ◦ Low back pain, referred pain ◦ Muscle spasm ◦ Increased lumbar lordosis ◦ Step deformity-one spinous process palpated anterior to next Medical Treatment ◦ Analgesics ◦ Spinal fusion

Answer 64

 Exercise – avoid extension that may add stress  Abdominal strengthening  Postural re-education  Modalities for pain relief  Abdominal binder  Patient education

Answer 65

Exaggeration of the normal posterior thoracic curvature  Excessive rounding > 45-50 degrees (20-40 degrees is normal) ◦ Can have rounded shoulders, forward head, and Dowager’s hump

Answer 66

◦ Can be from posture or disease ◦ Chronic spasticity of pectoralis major and minor, serratus anterior, weak rhomboid major and minor ◦ Osteoporosis in older persons ◦ Tuberculosis of vertebral bodies, ankylosing spondylitis, cancer, benign tumors, spina bifida, cerebral palsy, poliomyelitis

Answer 67

◦ Asymptomatic until hump becomes obvious ◦ Mild back pain and fatigue ◦ Decreased mobility of the spine ◦ Rounded back and shoulders ◦ Chest may cave in, head moves forward

Answer 68

Treatment ◦ Exercises ◦ Bracing ◦ Spinal fusion Physical Therapy Intervention  Strengthening of the back muscles  Stretching of the chest muscles  Postural education Kyphosis

Answer 69

 Structural ◦ Fixed curvature of spine due to vertebral rotation, asymmetry of ligamentous supporting structures ◦ Unknown (80% of cases) in adolescents or a congenital malformation of the spine and diseases ◦ Idiopathic  Functional (Postural, reversible) ◦ Caused by pain, poor posture, leg length discrepancy, muscle spasm ◦ Disappears when the cause is remedied ◦ Appears to change configuration when the

Answer 70

Scoliosis Test - Adam's rib was taken out to create Eve -Rib hump shows when person bends forward at the waist and hump/unevenness is observed from posterior view in person with scoliosis.

Answer 71

Treatment ◦ Prevention of postural or idiopathic structural scoliosis ◦ Monitoring every 2-6 months for curves < 25 degrees ◦ Body / back brace if curve is > 25-45 degrees ◦ Surgery if curve is > 45 degrees ◦ Spinal fusion

Answer 72

 Exercise programs: strengthening – trunk extensors, abdominals, gluteals to reduce muscle imbalances  Stretching; iliopsoas, low back extensors, lateral trunk flexors on concave side  Skin care with braces  Post Op ◦ Following physician protocol ◦ Segmental Stabilization vs. Harrington Bods

Answer 73

 Scheuermann’s disease  Structural deformity affecting adolescents between 12 & 16  Most common cause of kyphosis in adolescence  In the aging population, develops 2’ poor posture, disk degeneration, vertebral compression fractures, endocrine disorders, arthritis Clinical Manifestations  Adolescent kyphosis is usually asymptomatic  Prominent vertebral spinous processes  Tenderness and stiffness of spine  Tightness of pectoral, hamstring, and hip flexor muscles

Answer 74

◦ Aka hyperlordosis, saddleback, or swayback ◦ Exaggeration of the normal anterior curvature of the lumbar spine ◦ Can lead to degenerative disc disease or herniated discs in the lumbar spine Etiology ◦ Postural compensation for added abdominal mass, girth, as in pregnancy and obesity ◦ May accompany spinal disease such as osteoporosis or spondylolisthesis

Answer 75

Reduction in cell size Increase in cell size

Answer 76

Change of cell from one type to another

Answer 77

Increase in number of cells Decrease in number of cells

Answer 78

Description- ▫ muscle wasting with decrease in muscle cell diameter * Etiology ▫ Prolonged inactivity, poor nutrition, motor nerve dysfunction * Signs and Symptoms ▫ Muscle appears smaller, “looser”, “flattened” ▫ Decreased strength * Treatment ▫ Physical exercises/strengthening activities

Answer 79

Grade 1 ▫ Damage to less than 5% of muscle fibers ▫ Requires 2-3 weeks of rest Grade 2 ▫ More extensive damage but not complete rupture ▫ Requires 3-6 weeks of rest Grade 3 ▫ Complete rupture of the muscle ▫ 3 months of rehab ▫ If sports related: usually a surgical repair

Answer 80

▫ Inflammation of a tendon from microtrauma ▫ Usually due to repetitive motion/overuse, direct blows, or excessive tensile forces Treatment ▫ Rest, ice, analgesics, anti-inflammatories ▫ ROM activities

Answer 81

▫ Inflammation of the bursa (from overuse, trauma, gout or infection) Symptoms ▫ Pain w/ rest, limited ROM Diagnosis ▫ By clinical exam -swelling, pain Medical Management ▫ NSAIDS, acetaminophen, steroid injection PTA Role ▫ Flexibility exercises, ROM, STM, modalities

Answer 82

* chronic inflammation of plantar fascia Clinical Manifestations: * pain along medial border of calcaneous, pain is worse in a.m. * Possible increase of sx's with ankle DF Medical Management: * NSAIDS, acetaminophen, steroid injections (last resort) Interventions: * modalities, flexibility/stretching, joint mobilization, night splint, strengthening of invertors *Consider strengthening of inverter muscles as they help maintain the arch. Tib. Post & Ant. (main) and others(?)

Answer 83

Clinical Manifestations * overuse, repetitive trauma (overloading of tendon) Interventions * acetaminophen, NSAIDS, PT

Answer 84

Definition/Etiology: * occurs with sudden eccentric-concentric contraction * Usually 3-4 cm proximal to insertion * Men (age 20-50 yrs) * h/o corticosteroid injections Clinical Manifestations: * defect/gap of tendon, (+)Thompson Test Medical Management: ▫ Non-surgical (usually a period of immobilization) ▫ Surgical * Interventions: modalities, ROM, flexibility, strengthening activities

Answer 85

* aka Shin splints , anterior tibial periostitis Definition ▫ Musculotendinous overuse condition (ant. tibialis, extensor hallucis longus, post. tibialis) ▫ Caused by abnormal biomechanical alignment, poor conditioning, improper training methods ▫ Found often in runners (hard/uneven surfaces) Conservative Treatment ▫ Rest, ice, stretching, strengthening

Answer 86

Knee pain in growing adolescents, caused by fibers of the patella tendon pulling small bits of bone from the tibial tuberosity ▫ More common in boys 10-15 years Symptoms: knee pain, aching below (tibial tubercle), inflammation of patellar tendon ▫ Aggravated by activity Treatment: activity modification, decrease pain/swelling

Answer 87

aka Jumper’s knee, Runner's Knee Clinical Manifestations: * Pain directly over the patellar tendon * Pain with activities, particularly jumping * May be exacerbated by quadriceps tightness Interventions: * Protection phase: Rest, NSAIDs, modalities, gentle ROM, Stretching * Controlled motion and return to function phase: strengthening, dynamic control, pain free mobility, LE stability * Other: Braces or support straps, taping

Answer 88

Clinical Manifestations: * Minor pain; can radiate down the side of the arm * Sudden pain with reaching activities/overhead activities * Pain at night * Loss of strength Interventions: * Rest, NSAIDs, steroid injections * PT: limit overhead activities, ROM, posture, strengthening, stretching

Answer 89

 In laborers, athletes, those that have repeated overhead activities, faulty posture  Special tests: Hawkins Kennedy test, Neer’s impingement  Hawkin's Kennedy  Neer's  Treatment: Rest, ice, activity modification -> strengthening (scap. stabilization), posture -> return to activity

Answer 90

Clinical Presentation * Pain and weakness with overhead movement especially abduction Clinical Tests: * Drop Arm test (RC Tear), Empty Can (for supraspinatus) Surgery: may need ABD. pillow, NSAIDS, PT

Answer 91

Affects Extensors Common Manifestations: -Lateral Elbow Tendinopathy -Tennis Elbow Symptoms ▫ Pain over lateral epicondyle, usually with gripping activities/repetitive wrist extension ▫ Extensor carpi radialis brevis muscle -> may also involve extensor digitorum Management * Protection phase: decrease pain, immobilization prn, cross-friction massage, STM, passive stretching * Controlled motion and return to function phase: -passive stretching/flexibility, cross-friction massage, dynamic resistance exercises, strengthening

Answer 92

Affects Flexors and Pronator Teres Common Manifestation: - Bowler’s or Golfer’s Elbow  Involves common flexor/pronator tendon  Repetitive movements into wrist flexion  Less common than lateral epicondylitis Treatment * Refer to lateral epicondylitis treatment phases

Answer 93

Special Test: Finklestein's Test - tuck thumb into closed fist and ulnar deviate. * Inflammation of the abductor pollicis longus & extensor pollicis brevis (EPB) * Clinical Manifestations: Pain on radial side of wrist, increased with ulnar deviation, painful nodules, + Finkelstein Test * Interventions: Activity modification, bracing, RICE, stretching

Answer 94

* Formation of a flexion contracture, palmar nodules, and thickening band/cord of palmar fascia ▫ Usually involves 4th and 5th digits * Risk Factors: Diabetes*, heredity, DM, seizures, ETOH use, increased age * Nonsurgical Treatment * Surgical Treatment

Answer 95

95% of all ankle sprains involve lateral ligaments Combination of PF, inversion & adduction of the foot & ankle * ATFL * CFL * PTF: rarely torn, strongest of lateral ligaments Stepping off a curb, stepping on a rock or into a hole

Answer 96

* (+) Anterior drawer test - assesses the anterior talofibular ligament * (+) Talar tilt test - assesses the calcaneofibular ligament * Ecchymosis (bruising) * Swelling * Pain * Proprioception deficit * Decreased ROM * Restricted ambulation

Answer 97

Grade I * No loss of function with minimal tearing of ligament, usually the anterior talofibular Grade II * Some loss of function, partial disruption of anterior talofibular & calcaneofibular Grade III * Complete loss of function, complete tear of ATFL and CFL

Answer 98

1st & 2nd degree can be effectively managed non-operatively 3 Phases of intervention *Protection Phase - PRICE, gentle ROM (sagittal plane) pain free, pt. education, Isometrics (stronger ones can be used because we are talking about injured ligaments, not muscle) * Controlled Motion Phase - Continue with splinting, gait training, mobilizations, ROM, therex (avoid end-range), stretching of gastroc-soleus, balance activities, strengthening * Return to Function Phase - Strengthening with elastic bands, neuromuscular reeducation – add instability, unstable surface training, weight-bearing activities, return to sport/activity training

Answer 99

Grade I * An incomplete stretching of collagen fibers Grade II * Partial loss of ligament fiber continuity * A few may be completely torn, but most of the ligament remains intact Grade III * Completely torn * No continuity of the ligament

Answer 100

* Females > males Common mechanism: rotational -Contact: force applied to lateral aspect of knee resulting in a large valgus movement * May also injure MCL and medial meniscus - Noncontact: a) Tibia externally rotates on a planted foot b) forceful hyperextension of the knee Clinical Manifestations * Depending on the grade of the injury * ACL is intracapsular increased joint effusion * Joint instability Special Tests * Lachman Test (+) * Anterior Drawer Test (+) * Pivot Shift Test (+)

Answer 101

Operative management * Different procedures - * Autograft procedures - Gracilis tendon - Semitendinosus tendon - Patellar tendon Non-Operative Management * Progresses at a faster pace than surgery: Strengthening muscles to help stabilize knee

Answer 102

Method of Injury Caused by posterior tibial force – fall on flexed knee, hyperflexion of knee, hyperextension with foot planted Clinical Examination * Posterior Drawer Test * Godfrey Tibial Sag Test Treatment * Conservative – RICE, bracing, quad strengthening post acute phase * Surgical – autograft, allograft, limit knee flexion acutely ↓ stress on graft

Answer 103

* Most common ligament injuries seen * Usually from a direct contact to the lateral knee * Grade III MCL injuries are usually associated with an ACL lesion as well * Do not forget the medial meniscus and MCL are attached to each other * The Unhappy Triad (terrible triad) Clinical Manifestations * Patient may hear a pop * Swelling * Possible ecchymosis (sweating) * Impaired gait * Pain * Positive Valgus/Varus test

Answer 104

5 main types of tears * Horizontal * Longitudinal* (complete or incomplete) * Degenerative * Flap* (81% meniscal tears) * Radial

Answer 105

* C-shaped or semicircular fibrocartilage on the tibial plateau * Contain primarily (90%) Type I collagen * Function of the menisci * Stability, shock absorption, load transmission, nutrition, lubrication, reduce jt. stress

Answer 106

* Mechanism of Injury: Weight bearing with rotation or hyperflexion * Pain, clicking and possible locking Clinical Tests * Apley’s compression test * McMurray’s test

Answer 107

* Options are related to the location of the tear (red on red, red on white, or white on white) as well as the ability of the meniscus to repair itself Surgical indications: * Symptoms affecting ADLs * (+) finding on clinical exam * Failure of conservative Rx * Absence of other causes for knee pain * Lesion in vascular outer third of medial or lateral meniscus

Answer 108

Menisectomy * Avoid a total removal, usually partial Meniscal repair * Usually associated with an ACL repair * Usually WB more rapidly after peripheral zone repair * Meniscal transplantation * Allografts used restore normal function * Excellent results with proper indications followed

Answer 109

The undersurface of the patella can wear on the femoral surface causing pain. If the patella tracks laterally it is more likely to wear since the lateral femoral condyle is more prominent Anterior knee pain - Usually provoked by physical activity (running, squatting, stair climbing) * Women are affected 2x more than men Causes are multifactorial * Overuse injuries (Open chain quad with heavy weights and activities such as bicycling with seat low) * Patellar instability and lateral tracking * Direct trauma * Joint degeneration * Soft tissue length and strength imbalances

Answer 110

Patellofemoral Malalignment – resulting in increased Q angle and can cause lateral tracking of the patella. Causes include: 1. Patellar Position – patella alta 2. Tight IT band/lateral retinaculum 3. ↑external tibial torsion 4. Femoral anteversion 5. Foot pronation 6. # 3-5 together = miserable malalignment 7. VMO insuffciency 8. Hip abductor weakness

Answer 111

Primarily conservative treatment (PT) * Taping * Patellar braces * Foot orthotics * Patella mobilizations * Strengthening and stretching - hamstrings, rectus gastroc

Answer 112

* ‘Unidirectional instability’ ‘Hypermobility’ * 95% occur in anterior-inferior direction * UE is abducted, forcefully externally rotated * Causes tearing of inferior glenohumeral ligament, anterior capsule, and occasionally glenoid labrum * Most commonly dislocated joint in the body * May be atraumatic or traumatic (usually associated with complete rupture of RC) * High recurrence rate

Answer 113

* Humeral head in anterior inferior position upon observation * Pain, muscle guarding * Tests to check for anterior instability: * Apprehension Test * Anterior Drawer Test * Anterior Load and Shift

Answer 114

Non-operative * Initial protection of 4-6 weeks, occasionally immobilized * Avoid motions that reproduce the dislocation: abduction, horizontal abduction and ER Operative * Anterior capsulolabral reconstruction (Bankart Repair) * ROM limited per physician orders * Shoulder strengthening

Answer 115

* Shoulder pain, pain with overhead activities, weakness, instability * SLAP Tear * Locking, popping catching or grinding * Pain with movement or lifting * Clinical tests: Biceps load test, Slide test * Bankart Lesion * Shoulder pain not localized, but worsens when the arm is held behind the back * Weakness & instability * Clinical tests: Clunk tests

Answer 116

SLAP * Superior Labrum Anterior and Posterior * Commonly in pitchers * May also involve the biceps tendon Bankart lesion * At anteroinferior labrum * Coincides with anterior dislocation of the GH joint * Involves glenohumeral ligament

Answer 117

SLAP Tear - Nonsurgical * NSAIDs and PT for 3 to 6 months - Surgical * Arthroscopic * Immobilized 2-4 weeks * Follow post-op protocol, Avoid biceps strengthening and stretching since attaches to labrum Bankart Lesion - Nonsurgical * Not very effective; recurrent instability rate 17-96% under 30y old - Surgical * Arthroscopic or open, but does not significantly improve shoulder functionality * 1/3 of stabilized shoulder experienced dislocation after 8-10y

Answer 118

* The area between the clavicle and the acromion separates * Mechanism of injury - Most common is from a fall directly onto the shoulder or outstretched arm - Identified with a visible deformity, may also need a radiograph * Clinical tests: Step deformity and Positive piano key sign *Treatment - Non-surgical * Sling * Ice * Medications for pain - Most return to near full function. If full function does not return, then surgery will be the option

Answer 119

Grade 1 * Simple sprain of the AC ligament * Normal appearance on radiograph Grade 2 * Tear of the AC ligament & sprain of the coracoclavicular (CC) ligament Grade 3 * Tears of both ligaments and significant deformity

Answer 120

- Elbow MCL - Commonly affects baseball pitchers - Usually due to repetitive valgus stress * In particular pitchers, but can include, cheerleading, gymnastics and wrestling Symptoms * Pain along the medial side * May have a popping noise; catching * Occasionally swelling, if ruptured ecchymosis * Loss of elbow motion

Answer 121

Non-surgical Treatment * Medications for pain * Treat initially with rest and activity modification * Movement analysis * Strengthening exercises (elbow flexors) * Taping (for return to activity) Surgery * Failed conservative treatment * Arthroscopic if joint is not unstable * If acute injury * Direct repair * If chronic injury * May need to replace the ligament & reconstruction * Tommy John Surgery

Answer 122

* Incidence - ↑ in middle age (less than 45 y/o). Higher incidence in men. Less common in elderly, but disc are deteriorating so there is some risk. * Contributing Factors: * ↑ forces on the disc * Improper body mechanics – bending, lifting, posture * ↑ body weight/↓ overall fitness level

Answer 123

Signs & Symptoms * LBP – unilateral, bilateral, generalized * ↑ or radiates with sitting/ forward flexion * ↓ or centralizes with walking, trunk extension * Is affected by side bending if spinal nerve is laterally or medially impinged Radicular Sx * Along dermatomes or along sciatic nerve * Pain, paresthesias, hypethesias * Muscle weakness along myotome

Answer 124

* Posture – lateral shift (correctable?), ↓ lordosis, forward bend, weight bears on hands in sitting * Palpation – tenderness, spasms, edema * AROM – LOM, affect of ROM on pain (centralizes or peripheralizes) * Compression/Distraction * Quadrant Test * SLR + if LBP at 30 – 60 ̊ * Slump Test * Neurological * Tests for Malingering (pt. faking sx's) * Waddell’s - tests for symptom magnification * Hoover Test – cup hands in heels to determine if trying to lift LE

Answer 125

Diagnostic Tests * Radiographs (rule out fracture, not diagnostic for herniation) * MRI * Myelogram * EMG

Answer 126

Conservative * Modalities * Exercise, normalize WB, progress to spinal stabilization * McKenzie Exercises (performed by standing and leaning back) * Education * Nerve glides (flossing) * Oral Medication/Epidural Injections * Spinal Supports Surgical * Discectomy – posterior/anterior approach * Laminectomy with discectomy * Surgeon could choose to fuse affected vertebrae * Microdiscetomy –minimally invasive * Disc Replacement * IDET-intradiscal electothermal therapy

Answer 127

* Falls * Disease-Ankylosing spondylitis * Muscular forces acting on pelvis: check for weakness(stabilizers-abs, gluts) and tightness of muscles * Remember that tightness in the hip can transmit forces to the pelvis * (hamstrings, hip flexors, rotators of hip)(if tight-stretch, while stabilize pelvis) * Pregnancy and ligamentous laxity * Improper lifting or twisting * LLD

Answer 128

* Anterior and posterior torsion (rotation) - One side of pelvis (ilium) is rotated (not the whole pelvis turns - remember SI Joints) (No need to know these for test) * Upslip vs. Downslip - Entire side slips up or down * Innominate outflare (ASIS out) * Innominate inflare (ASIS in)

Answer 129

1. Posture: pelvic asymmetry 2. Palpation 3. Testing hip and abdominal muscles 4. FABER (Flexion, ABduction, ER) test SI joint motion-is it hypermobile or hypomobile? * A. Forward Flexion test- research shows not good method * B. Compression and Distraction Tests * C. Injections of local anesthetic by physician

Answer 130

“CVA”, a stroke, or a “brain attack”  Sudden, focal disruption in cerebral blood flow, with death of brain tissue leading to irreversible brain damage  Symptoms last more than 24 hours  Men > women  Leading cause of disability and 3rd leading cause of death in the US

Answer 131

Stroke symptoms that last LESS than 24 hours

Answer 132

- Cerebrovascular disease; primary cause  Damage to blood vessels of brain - Risk Factors  Increased age (> 55 yrs.)  Race: increased in African Americans  Men > Women  Family h/o stroke  HTN  Heart disease  DM  Cigarette smoking

Answer 133

Hemorrhagic CVA  Ruptured blood vessel  Aneurysm ruptures -> blood seeps into surrounding tissue and creates pressure -> symptoms dependent upon which area of the brain is affected Ischemic CVA (Most common, 85% of strokes)  Blood clot in cerebral arteries/branches  Atherosclerosis leads to an embolus -> clot travels and blocks a smaller blood vessel in the brain -> lack of oxygen leads to brain tissue necrosis

Answer 134

Face is uneven, weak, or numb Arm is weak or numb Speech is strange Time to call 911

Answer 135

Impairments will vary depending on the area, but may include:  Aphasia Expressive: ‘Broca’s’= interrupted/awkward words Receptive: ‘Wernicke’s’ = fluent, spontaneous speech, impaired auditory comprehension Global: combo of expressive & receptive  Dysphagia: difficulty swallowing  **may lead to aspiration (incr. risk of respiratory distress & pneumonia)

Answer 136

a vital ring of arteries at the base of the brain that connects the internal carotid and vertebrobasilar systems, acting as a crucial "bypass" or collateral pathway to ensure continuous oxygenated blood supply to the brain, even if one of the major arteries becomes blocked, preventing or reducing the impact of strokes and ischemia

Answer 137

Left: - Right side paralysis - Speech and memory deficits - Cautious and slow behavior Right: - Left side paralysis - Perceptual and memory deficits - Quick and impulsive behavior

Answer 138

Aphasia Expressive: ‘Broca’s’= interrupted/awkward words (sometimes called "non-fluent") Receptive: ‘Wernicke’s’ = fluent (as in words just flow out - doesn't make sense), spontaneous speech, impaired auditory comprehension Global: combo of expressive & receptive Dysphagia: difficulty swallowing  **may lead to aspiration (incr. risk of respiratory distress & pneumonia) Hemiparesis: one-sided weakness Hemianopsia: loss of vision Flaccidity: transient decrease or lack of resistance to PROM (immediately after spinal shock after injury) Spasticity: increased resistance to PROM (spasticity is always associated with CNS disorder) (velocity dependent)

Answer 139

 Immediate medical attention, within 90 minutesafter onset of symptoms  Imaging: CT Scan  *Clot-busting medications: tPA (tissue plasminogen activator) - Clot-busters are not anti-cuagulants  Anticoagulants for ischemic type  Control of hypertension and brain bleeds for hemorrhagic type  Reduce hypertension and blood cholesterol, anticoagulants or antiplatelet treatment

Answer 140

* May begin in ICU if indicated for bed mobility and range of motion, progressing to strengthening exercises and ambulation as tolerated * Training on how to use the affected and neglected extremities * Gait training and adaptive equipment as necessary * Follow precautions

Answer 141

 Brief episode of impaired brain functioning due to a temporary reduction of blood flow  Individual remains conscious  Complete recovery in 24 hours with no residual dysfunction; > 24 hours is a CVA  Can indicate development of CVA or stroke (1/3 of patients)  Etiology, signs and symptoms, and treatment are the same as those of a CVA

Answer 142

 a head injury, with external physical force affecting brain function  Impairment of cognition and physical function which can be temporary or permanent  Initially, diminished/altered state of consciousness  Behavior and emotional changes

Answer 143

 Open injuries - meninges are breached and the brain is exposed  Closed head injuries  Epidural or subdural hematoma occurs -> blood creates pressure on brain tissue -> ischemia of brain tissue  Edema of brain tissue -> diffuse pressure on brain -> increased intracranial pressure - Primary injury: direct damage to brain - Secondary injury: bleeding or something after the fact

Answer 144

The brain hits one part of the brain as well as the directly opposing part of the brain  Creates a shearing effect

Answer 145

 Mild to severe range  Loss of consciousness, seizures, coma, death  Headaches, dizziness, nausea and vomiting  Altered cognition, changes in personality or emotions, retrograde or posttraumatic amnesia, post-traumatic stress disorder, anterograde amnesia (can't make new memories)  Glasgow Coma Scale (level of conciousness)  (3-15 scale; lower = more impaired 3 = coma, doesn't go lower)

Answer 146

 Cognition/Arousal  Memory  Anterograde (after the accident)  Retrograde (before the accident)  Hypertonicity and hypotonicity  Possible fractures and soft tissue injuries  Strength and ROM issues

Answer 147

* Treatment will begin in the ICU * PROM, progressing to more active strengthening with transfer training, wheelchair training, and gait training * Must be aware of the patient’s cognitive deficits in order to communicate with and teach the patient appropriately

Answer 148

 Rest and recovery  Restore strength and activity tolerance  Eliminate dizziness and improve balance  Reduce and eliminate headaches  Return to normal sport/activity

Answer 149

 Autoimmune disorder  Chronic, progressive demyelination of neurons of the brain, spinal cord, cranial nerves (of CNS), sclerotic plaques  Periods of remissions and exacerbations  Women > men (at least 2:1); onset between 20 - 50 years old  Fluctuating periods. Both relapsing-remitting (most common) and primary progressive  Exacerbations related to stress, heat, fatigue, infections

Answer 150

 Genetic defect reducing the ability of T-cells to turn off the immune response -> autoimmune attack on the myelin -> scar tissue causes plaques which build up in spinal cord and brain -> disruption of brain function and neural transmission

Answer 151

Relapsing-Remitting  Characterized by attacks (most common 85%), exacerbation/remission, may have minimal long-term impairment - Up and down on graph with gradual progression overtime Primary progressive  Steady decline in function with min recovery -Acute onset, steady straight curve progression Secondary progressive  50% change into this from R-R. into progressive -Starts out as up-down and turns into straight curve on graph (Combo of first two ^) Progressive relapsing  Rarest form, progressive with periodic acute relapses - straight progressive curve with large ups, but no valleys.

Answer 152

 Demyelination causes the primary symptoms  Paresthesias, vision disturbances (diplopia), progressive muscle weakness, cognitive impairments, and bladder and bowel dysfunctions, fatigue (especially in afternoons)  Secondary symptoms result from primary symptoms  Tertiary symptoms include social and psychological functioning

Answer 153

 Team approach including physicians, psychologists, social workers, physical therapists, occupational therapists, speech therapists, and family  Medications to reduce the development of new brain lesions and slow down disease progression (ABC drugs)  Corticosteroids  Avoid exacerbating factors: infections, trauma, pregnancy, stress

Answer 154

* Treatment focuses on maintaining mobility and the quality of life, * Reduce fatigue: stretching, aerobic exercise, and education regarding fall prevention and energy conservation techniques. * May need to avoid heat * Coordination exercises * Limit strengthening/resistive: may increase fatigue

Answer 155

 Chronic, progressive, degenerative neurologic disorder of the basal ganglia  Produces syndrome of abnormal movements  Deficiency of dopamine and degeneration of substantia nigra ▪ Dopamine ▪ Regulates voluntary movements, emotions, mood, motivation

Answer 156

 Slowly progressing  Tremors – “pill-rolling” Most common initial manifestation  Cogwheel/Lead-pipe rigidity  Bradykinesia  Akinesia: movement initiation  Slowness of voluntary movements  Gait changes: narrow, shuffling  Flexed posture  Decreased balance  Masklike appearance of the face  Mentation deficits: slowing of thought, depression, dementia  Muffled speech  Difficulty with chewing and swallowing  Deconditioning  Parkinson's Gait  Resting Tremor

Answer 157

Incurable  Prescribed medications to slow the development of dopamine : levodopa / carbidopa-levodopa (sinemet) , or anticholinergic medications(control tremors)  Surgery  Deep brain stimulation, stem cell implantation  Speech therapy for speaking and swallowing  Occupational therapy for ADLs

Answer 158

* Treatment focuses on addressing the patient’s functional deficits, promote independence * Range of motion exercises, strengthening, balance training, gait training, posture, flexibility, spinal flexibility * Instruction in use of assisted devices to maximize the patient’s mobility * Manage home environment

Answer 159

 Autosomal dominant, progressive degenerative disorder  [Genetic] Caused by mutation of the gene which produces huntingtin protein  Motor disturbances, mental deterioration, abnormal behavior  Slow progression from 10 - 30 years before death, symptoms appear in the 30s and 40s  1 in 20,000 in U.S. affected

Answer 160

 Chorea - involuntary, purposeless, rapid or jerky motions of the arms and face (Herky jerky)  Dystonia – increased muscle tone, involuntary movements with rotation (writhing)  Myoclonus – involuntary twitching and spasm  Movement tics – brief muscular spasms on the face  Abnormalities of eye movements  Parkinson – like movements – rigidity and tremors  Dysarthria: decreased rate and rhythm of speech

Answer 161

* Treatment focuses on maintaining independence for as long as possible * Apraxia becomes severe – may lose ability to perform ADLs * Strength, flexibility, and endurance training; progressing through wheelchair training or ambulation with assistive devices, positioning * Education regarding fall prevention and energy conservation techniques for both the patient and the family.

Answer 162

 Epilepsy and epileptic syndromes  Explosive episodes of uncontrolled and excessive electrical activity in the brain which results in multiple involuntary muscle contractions  Diagnosis of epilepsy requires 2 seizures occur without a known cause

Answer 163

 Abnormalities within the neurons or with the balance of the neurotransmitters, which cause the neurons to be triggered all at one time  Unknown, possibly genetic factors involved  Head trauma or brain tumors  Infections, high fevers

Answer 164

 Medical Conditions Hyponatremia, hypernatremia, hypoglycemia  Neurologic Conditions Stroke, brain tumor, meningitis  Drug Induced Seizures Drug or alcohol withdrawal  Illnesses Eclampsia, renal failure, sickle cell disease

Answer 165

 Absence seizures – “petit mal”, with brief loss of consciousness, staring  Atonic – temporary, sudden loss of muscle tone, collapses  Myoclonic / myotonic, Clonic/tonic-”grand mal”– jerking and twitching, loss of consciousness  Simple partial – emotion and sensation changes, consciousness maintained  Complex partial – altered level of consciousness, staring, twitching

Answer 166

 Prescribed medications acting on neurotransmitters  Barbiturates : Phenobarbital (long acting), Pentobarbital  Benzodiazepines: Diazepam (Valium), Lorazepam (Ativan)  Dilantin, Tegretol, Lamictal  Vagal nerve stimulation  Surgery to remove the affected area of brain  Ketogenic diet, gene therapy, stem cell research

Answer 167

 What do you do if your patient had a seizure while you were treating them????  SAFETY!!! Both the patient and you! Protection  Remove all objects from the area  Do NOT restrain them  If they are standing lower them to the ground safely  Turn them on their side if able to allow for vomit to exit the mouth  DO NOT put your anything in patient’s mouth  Vitals, length of seizure time  **Status Epilepticus -> Medical Emergency, seizure > 30 minutes

Answer 168

A seizure is a single electrical event in the brain, while epilepsy (or a seizure disorder) is a chronic neurological condition defined by recurrent, unprovoked seizures, meaning they happen without an immediate trigger like fever or injury. Not every seizure means epilepsy; a provoked seizure (due to infection, trauma, drugs) may not lead to epilepsy, but recurring, spontaneous seizures diagnose the disorder.

Answer 169

* Treatment is aimed at the injuries or conditions resulting from the seizure, such as fractures or developmental delays. * may include work on mobility, stretching, strengthening and balance. It is important to be aware of seizure precautions if a patient has had a prior neurological injury

Answer 170

 Progressive degenerative disease of the brain  Destroys cerebral cortex neurons  Leads to dementia  500,000 new cases diagnosed each year

Answer 171

 Exact cause unknown  Risk increased with advancing age, genetics, atherosclerosis  Plaques and amyloid accumulate in brain tissue -> neurofibrils break down and become tangled -> nerve impulse transmission prevented -> function of sections on the cerebral cortex destroyed  Neurofibrillary tangles detectable at autopsy

Answer 172

 Loss of memory, inability to concentrate, impairment of reasoning, apathy, personality changes  Warning signs: memory loss, problems with language, disorientation, difficulty completing familiar tasks, distorted judgment, problems with abstract thinking, misplacing things, mood, behavior, and personality changes  Sundowning - increase in symptoms at the end of the day

Answer 173

 Prevention including healthy diet, higher education [challenging your brain]  Medications  Stem cell research  Massage  Supportive environment, and long term

Answer 174

* Goal is to maintain functional independence for as long as possible by encouraging activity, as the disease may lead to inactivity due to the cognitive restrictions. * Strengthening, balance activities, maintain ROM * Due to the patient’s cognitive status, the therapist must use short, clear, and concise instructions. * Short and simple exercise sessions

Answer 175

Types: Lewy body, senile, vascular, and dementias precipitated by other diseases  Progressive brain deterioration  Decline of mental facilities (thinking, remembering, communicating)  Affect a wide age range

Answer 176

* Treatment is aimed at the neurological and musculoskeletal manifestations, and must be adjusted due to the patient’s cognitive status by using short instructions and a familiar location. * Work on stretching, strengthening, endurance, balance and coordination, as well as ambulation may be indicated.

Answer 177

 Also called Lou Gehrig’s Disease (baseball player) - Degeneration and demyelination of MOTOR neurons  Acute onset; Leads to general paralysis and immobility; progresses rapidly, with death usually in 3 - 10 years (Steven Hawking had a different form of ALS and lived for roughly 50)  50% have cognitive impairments  Mainly occurs between 40 and 60 years of age, with men > women; 2 case per 100,000  5th decade or later

Answer 178

Begins with weakness and rapid atrophy (not from disuse) of hands, forearms, legs and eventually spreading to rest of the body Severe fatigue Paralysis Difficulty with speech, chewing, swallowing, breathing

Answer 179

 Medications to control muscle spasms  Assistance with breathing including intermittent positive pressure ventilation (IPPV) or tracheostomy

Answer 180

"Palliative" care "Goal is to maintain independence and functional independence for as long as possible * Work on functional mobility, including wheelchair evaluation and training if needed * Home modifications and assistive devices * Strengthening and stretching * Low-impact aerobic exercise * Breathing exercises, postural drainage, chest PT

Answer 181

 Damage to the vertebrae, neural tissue  Loss of movement and sensation distal to injury site  Quadriplegia or paraplegia  Men > women 4:1; ages 15 - 25  12,000 new cases each year in the U.S.

Answer 182

Immediate Phase (Don't need to know the specifics of the phases) Lasts up to 2 hours after the injury Spinal shock, with no movement, sensations, or reflexes below the level of the injury Edema in the spinal cord -> hemorrhage and death of gray and white matter cells -> ischemia of spinal cord Acute phase  From 2 – 48 hours after injury  Hemorrhage continues -> increased inflammation and edema -> free radical production -> damaged tissue -> immune system response -> neural and glial cell damage Subacute phase  From 2 days – 2 weeks after injury  Phagocytes clean-up debris and destroy myelin -> scarring -> barrier for axon regeneration  Intermediate Phase  From 2 weeks – 6 months after injury  Scarring matures -> axon regeneration Chronic Phase  From 6 months – the end of lifetime  At 1-2 years, symptoms and deficits occurs  Bone density loss, pressure ulcers, depression, suicidal thoughts, hostility, substance abuse

Answer 183

 Impairments will vary depending on the injury, but can include  Impaired sensation Temperature Light touch Kinesthetic  Impaired motor function  Impaired bowel & bladder  Ipsilateral and contralateral depending on the injury

Answer 184

 A medical EMERGENCY in SCI patients  Above the T6 level  Diaphoresis (excessive sweating) along nerves above T6, high blood pressure, increased HR  Usually associated with a full bladder or blocked catheter  Sit patient up and check for noxious stimulus and get help!!!! Order of operations (MUST FOLLOW): 1) Sit them up if they're lying down, check for pinched catheter - lower blood pressure to brain (DON'T lay them back down if they have orthostatic hypotension) 2) Check for (painful or uncomfortable) noxious stimulus 3) Get help or Call 911!

Answer 185

* Treatment focuses not only compensatory movements, but also on recovery. * Strategies include functional electrical stimulation and passive range of motion, progressing to more active strengthening and balance training. * Treatment also includes transfer training, wheelchair training, and gait training

Answer 186

PNS PPT slide 4, (Picture on Phone)

Answer 187

 Cell body of the alpha motor neuron  Axons that arise from the anterior horn  Motor Endplate of the Neuron (where it hits muscle)  Muscle fibers innervated by that axon

Answer 188

- mesis = to cut PNS PPT. Slide 7 (Picture on Phone)

Answer 189

Also known as: "Acute/Ascending Idiopathic Demyelinating Polyneuropathy" (AIDP) Rapidly progressing inflammatory disease in which the immune system affects the neural tissue - related to the immune system but not an autoimmune disease - can be recovered from. Etiology  Unknown  Related to autoimmune response preceding viral infection or immunization Signs & Symptoms  Numbness or tingling in feet and hands  Followed by progressive muscle weakness beginning in legs and traveling up the trunk, down the arms to the face, usually bilaterally, with possible complete paralysis  Vision, speech, and breathing may be impaired  Absent deep tendon reflexes  High level of proteins in the cerebrospinal fluid

Answer 190

 No known cure  Plasmapheresis to reduce the autoimmune response and remove toxins  Intravenous immunoglobulin to restore immune defenses  Manage symptoms of dehydration and skin breakdown  Psychological support for patient and family - PT Treatment follows the pace of peripheral nerve recovery, and usually begins with patient and family education in range of motion exercises to prevent contractures, progressing through wheelchair training or ambulation with assistive devices, strengthening, and balance and coordination activities. It is important not to overfatigue a patient. - Holly Frances recover video documenting getting the condition 3 wks after pregnancy.

Answer 191

 NOT a re-infection of the Polio virus  Seen in some patients who have had poliomyelitis earlier in life  Appears an estimate of 35 years after infection  Exhibited in 28.5 to 64% of previous polio patients  Increased occurrence due to polio epidemic in 1940s and 1950s - Previously injured nerves force healthy nerves to pick up the slack and after a couple decades those healthy nerves are overworked and start to break down causing Post-Polio Syndrome.

Answer 192

 Develop slowly  Weakness and decreased muscular endurance, “post-polio progressive muscular atrophy”  Fatigue, loss of energy, myalgia  Decreased concentration, mental exhaustion  Respiratory, speech, and swallowing problems  Joint problems, inflammation; leads to decreased mobility and function Treatment  No cure  Medications not effective  Manage physical effects of weakness through lifestyle changes - Energy conservation techniques including rest and use of a wheelchair - Low-impact aerobic program Strengthening program without fatiguing

Answer 193

- Umbrella term Disease of the peripheral nerves  Affects motor, sensory, autonomic systems  > 20 million affected; more common in older adults Etiology (Don't need to memorize)  Unknown; inherited  Diabetes mellitus, Guillain-Barre  Alcoholism  Autoimmune diseases  Kidney failure, thyroid dysfunction, cancer  Environmental toxins; Infections  Long-term medications  Vitamin B deficiency, malnutrition

Answer 194

 "Glove and Stocking Pattern"  Sudden or gradual, > in distal lower extremities  Mild to severe and debilitating  Pain during regeneration of nerves  Weakness and atrophy, fasciculations, cramping  Altered sensation: “Glove” distribution, vibratory, touch, pressure, temperature, numbness, kinesthetic  Decreased balance, coordination, mobility  Decreased weight bearing -> bone degeneration  Hypotension -> dizziness, poor balance  Facial muscle weakness -> swallowing, eating difficulties  Bowel / intestinal symptoms  Can result in skin breakdown, amputation Treatment  Team approach  Treat underlying cause  Lifestyle changes  Medications to decrease pain  Orthopedic shoes - Treatment begins with PT evaluation of muscle strength, skin sensation. The treatment plan may include orthotics, wound care, prevention of contractures, gait training, balance training, strengthening, endurance, and patient education.

Answer 195

 Autoimmune disease  Neurologic disorder characterized my impaired transmission of motor neurons  Antibodies are produced that attach and destroy acetylcholine receptors in the neuromuscular junction  Excessive amount of cholinesterase ▪ Enzyme that deactivates acetylcholine  Stimulation of muscles is prevented leading to progressive weakness  Respiratory muscles affected Review: Acetylcholine (ACh) is a vital neurotransmitter for muscle contraction, learning, memory, and autonomic functions like heart rate, digestion, and glandular secretions, acting as a chemical messenger between neurons and other cells in both the central and peripheral nervous systems

Answer 196

Signs and Symptoms  Facial weakness and loss of expression  Muscles of eyes, mouth, throat, neck affected  Vision impaired  Fatigue - Use "Sleepy" the dwarf as an illustration Treatment  Pharmacotherapy - Focused on functional activities, including activities of daily living, with possible adaptive equipment, breathing exercises, and occasional exercise programs, being very careful to avoid fatigue.

Answer 197

 AKA Idiopathic Facial Paralysis  Common clinical condition  20 of 100,000 people each year  Most common between ages 15 to 45  *Affects the (7th) Facial Nerve unilaterally

Answer 198

 Days before severe pain in the area of the mastoid  Facial paralysis that develops rapidly  Dry eye on the affected side  Increased sensitivity to sound on the affected  Also affects salivation and lacrimation (flow of tears) Management:  Prophylactic administration of high dose steroids for 5 days f/b a tapered dose for 5 days  Treatment should begin no later than 10 days after onset  Antiviral medications  95.7% recovery rate  Use of an eye patch to protect the cornea  Electrical stimulation should NOT be used  Twice daily exercise program

Answer 199

 Those with TOS have vague symptoms  Remains a controversial diagnosis  It is complex and poorly defined  Patient’s are labeled  It is an entrapment syndrome  Places pressure on the structures in the outlet  Brachial Plexus fibers  Subclavian artery  Chronic compression of the spinal roots, proximal plexus and arteries  Compression between the clavicle and first rib  Impinging musculature  Results in edema and ischemia n the nerves Review: The brachial plexus is a complex network of nerves originating from the lower neck (C5-T1 spinal nerves) that controls movement and sensation in the shoulder, arm, forearm, and hand, running from the spine through the armpit to the limb. Review: The subclavian artery is a major blood vessel located beneath the collarbone (clavicle) that supplies oxygen-rich blood to the head, neck, and arms, with distinct left and right arteries originating from the aorta and brachiocephalic trunk, respectively, transitioning into the axillary artery at the first rib. Issues like narrowing (stenosis) or blockage can cause symptoms such as arm fatigue, pain, numbness, dizziness, and visual changes, often due to conditions like atherosclerosis or thoracic outlet syndrome.

Answer 200

Neurogenic  Compression of the brachial plexus Vascular  Compression of subclavian vessels Disputed  Nonspecific w/chronic pain & symptoms of plexus involvement

Answer 201

 Signs & symptoms reflect the structures that have been compressed  Paresthesias and pain in the arm *Primarily nocturnal  *Upper Plexus injury (C5 to C7) * Pain in neck and radiating to face  *Lower Plexus injury (C7 to T1) * Pain numbness in posterior neck down the arm  Weakness in muscles that correspond to the impaired nerve root  Coldness & Edema in arm & hand * Raynaud’s Phenomenon - a condition causing blood vessels, usually in fingers and toes, to narrow (vasospasm) in response to cold or stress, leading to color changes (white, blue, then red), numbness, and tingling as blood flow is restricted and then returns

Answer 202

Tests:  Provocative tests are used to elicit symptoms  They have a high false (+) rate  Maneuvers are performed bilaterally  TOS tests  Radiographic test  NCV testing Treatment: - Conservative  When symptoms are mild  Postural and breathing exercises  Strengthening traps, levator scap & rhomboids  Avoiding overhead activities - Surgical  Reserved for cases that are refractory to postural & exercise correction  Vascular compromise  6 different procedures & 6 different approaches ▪ Scalenectomy ▪ Clavicle resection

Answer 203

Cubital Tunnel Syndrome  Elbow - Causes  Mobile nerve over the epicondyle  Leaning on the elbow for long periods  Fluid build up  Direct trauma Compression @ Guyon’s Canal  Wrist - Cause  Soft tissue tumors (ganglion cyst)  Repetitive trauma ▪ Like using a jack hammer  Chronic pressure ▪ Bicyclists

Answer 204

 Numbness in the 4th & 5th fingers  Weakness in grip and decreased coordination  Depending on how long, muscle atrophy in hypothenar muscles

Answer 205

 Most common entrapment neuropathy  Compression of the median nerve  3.5 cases per 1000 individuals  Prevalence 2.1%  70% of all CTS cases occur in women  500,000 surgeries performed annually 10 Structures that go through the Carpal Tunnel: Median Nerve, Flexor PIP (4) and DIP (4) tendons, and Flexor pollicis longus.

Answer 206

Clinical Manifestations  Symptoms in the Median Nerve distribution  Pain may be located in the forearm and radiate into the thumb, index and middle fingers  Nocturnal pain is hallmark  Thenar weakness in advanced cases Management  Must be distinguished between cervical radiculopathy or ulnar neuropathy  (+) Phalen’s test  (+) Tinel’s test  NCV Testing  No universally accepted treatment  Median Nerve Glides

Answer 207

Review: Sympathetic NS - fight or flight response  Also known as Causalgia, Reflex Sympathetic Dystrophy  Chronic pain condition  Continuous, intense pain out of proportion to the severity of the injury  Most often affects one arm, leg, hand, or foot Etiology  Unknown  Sympathetic nervous system can play a role  Immune response triggering inflammatory response - inflammation triggers more pain - turns into positive feedback cycle.

Answer 208

S & Sx  Pain that begins in a portion of a limb and can spread to the entire limb  Changes in color and temperature of the skin  Intense burning pain, skin sensitivity, sweating, swelling Treatment  Focused on pain relief  Corticosteroids, opiates, antidepressants (CNS depression)  Sympathetic nerve block, spinal cord stimulation, intrathecal drug pumps  No drug or combination of drugs have produced consistent long-term improvement in symptoms

Answer 209

Early mobilization of the limb post-surgery Modalities to decrease pain and hypersensitivity Tactile desensitization activities Exercise, reduce guarding of affected limb Physical Therapy is sometimes controversial , can be unsuccessful

Answer 210

bactericidal - kills bacteria bacteriostatic - inhibits the growth of bacteria iatrogenic - disease caused from the unclean hands of healthcare workers

Answer 211

* Staph bacteria among most common bacterial pathogens normally residing on the skin *Staph aureus * Leading cause of nosocomial and community acquired infections * Risk Factors: Direct contact with colonized surfaces * Most common locations: Nares, skin, axilla, perineum, vagina, oropharynx * Diabetics, HIV+, IV drug users, hemodialysis patients, chronic skin lesions, surgical/burn patients, RA, corticosteroid therapy

Answer 212

* S.aureus cannot invade through intact skin * May enter through damaged skin * Usually produces an abscess or other skin infections – cellulitis, boil-like lesions * Fever, chills, and symptoms with the affected body part

Answer 213

- I.V. ABx of Vancomycin (Currently only thing that can kill this bacteria) * Requires contact isolation * Often used in the treatment of total joint infections Note: Primary reason for anti-biotic resistance is not taking the full course of anti-biotics.

Answer 214

* Usually in the urine * s/s: bloodstream infection (sepsis), UTI, abscesses, wound infections * Treated similarly to MRSA

Answer 215

* Methicillin-Resistant Staph Aureus (MSRA) * VRE Special Implications for the PTA * -handwashing, cleaning of equipment

Answer 216

* An anaerobic spore forming bacillus – inflammation of colon -> mild diarrhea to severe colon inflammation and possible death * Occurring exclusively in the presence of prolonged exposure to antibiotics * Primarily transmitted in health care facilities * Fecal- oral route * Requires contact isolation * Pathogenesis- Change in the protective flora * Induced by ABx * Acute and persistent diarrhea **Anti-biotic DO NOT CAUSE C-diff. Everyone has C-diff. Your good natural gut bacteria keeps usually keeps it at bay, but anti-biotics kill your good gut bacteria, allowing room for C-diff to grow. (Suddenly empty apartment block illustration)

Answer 217

Proper hand washing Cleaning all the equipment that came into contact with the patient Contact Isolation techniques observed: Wear gloves and gown Do NOT use hand foams when working with a patient with C-Diff. Must wash hands.

Answer 218

is an infectious, inflammatory systemic disease that affects the lungs and may disseminate to involve lymph nodes and other organs * It is characterized by caseous (cheesy) necrosis and subsequent cavity formation typically in the lungs. (Myobacterum tuberculosis) * Risk Factors * Immunocompromised: HIV infection * Over 65 years of age * Economically disabled persons * It becomes established in the lungs from inhaled droplet * TB is an easily spread (contagious) disease.

Answer 219

Stay alert to prevention of spread Fit masks (N95 or better) PPD : usually required yearly Confine care to the patients room (negative pressure room with door closed at all times)

Answer 220

- Description: AKA herpes virus type 5, CMV * Most common congenital virus in U.S.; 1 in 150 infants affected, 1 in 5 develop permanent disability * Related to herpes viruses - Etiology: Present in all body fluids, transmission through close contact with infected fluids * May be passed to fetus through pregnancy or breast milk

Answer 221

- Signs and Symptoms: May or may not be present; may mimic influenza * Newborn symptoms: low birth weight, microcephaly, respiratory problems, mental and motor delays, seizures * Immunocompromised: colitis, pulmonary infections, encephalitis, neuropathy, retinitis * Organ transplant patients (you're on immunosuppressants to keep the body from rejecting the new organ) - Treatment * Infants treated with antiviral medication to prevent hearing loss * Antiviral medications for complications

Answer 222

* Physical therapy not directly indicated * Handwashing * If pregnant, do not work with patients who have CMV

Answer 223

* Group of liver infections and diseases caused by various viruses Several types * Hepatitis A (HAV) * Hepatitis B (HBV) * Hepatitis C (HCV) * Hepatitis D (HDV) * Hepatitis E (HEV) * Hepatitis G (HGV) * Alcoholic Hepatitis

Answer 224

Symptoms * Loss of appetite, nausea and vomiting * Weakness, fatigue, joint and muscle pains, aching * Fever, skin rash * Jaundice, dark-colored urine Treatment * Prevention, vaccinations * Medications - antivirals PT Interventions * Not directly indicated * Standard Precautions * Immunizations *Hep B can stay on surfaces for 7 days

Answer 225

* > 85% develop chronic form * Etiology * Transmitted via infected blood * RNA virus, transmitted through blood * Most common in those persons who use IV drug use or have multiple sexual partners

Answer 226

Signs and Symptoms * Usually mild * Reduction in appetite, abdominal pain, tenderness over liver region * Muscle and joint pain * Jaundice, cirrhosis Treatment * Prevention * Medications (can't miss a dose) * Harvoni * Possible liver transplant if severe PT Intervention: Since there is no real cure - Treatment of associated arthritis and fibromyalgia.

Answer 227

* HIV = human immunodeficiency virus * AIDS: progressive destruction of cell-mediated T- cell immunity * CD4 count (asymptomatic CD4= 500 or more) * Etiology: blood-borne pathogen * Transmitted via blood and bodily fluids: sexually, shared hypodermic needles, blood transfusions (1980s) *Secondary / opportunistic infections (Important to know these): * Pneumonia, herpes simplex and zoster, non-Hodgkin’s, CMV, candidiasis, Karposi sarcoma * Treatment * Pharmacology: HAART (highly active antiretroviral therapy) * Focus on disease prevention

Answer 228

Reactivation of the Herpes Varicella (chicken pox) virus If you had chicken pox prior you can't catch shingles. HOWEVER, if you never had chicken pox you CAN CATCH it from someone with shingles.

Answer 229

Clinical Manifestations * Vesicular eruption * Unilaterally * Dermatomal pattern * Usually the trunk or the 5th cranial nerve Symptoms * Fever, chills, malaise, tingling along the dermatome * Severe neuralgic pain * Scarring and degenerative changes involving the nerve trunks, ganglia, and skin * May lead to postherpetic neuralgia

Answer 230

Description: Lousiness or pediculosis * Is an infestation by Pediculus humanus * Usually from shared personal item (comb) Clinical Manifestations * Severe itching * Small grayish, white nits in the hair Treatment * cleaning solutions (specialized shampoo) Implications for the PTA * Contact isolation

Answer 231

* Highly contagious skin eruption caused by mites * Common public health problem * The female mite burrows into the skin and deposits eggs which hatch in a few days * Transmitted skin to skin contact or via contaminated objects * Can spread rapidly Clinical Manifestations- Intense pruritus (itching) * Excoriated skin * Mites are found in the interdigital web spaces, flexor aspects of the wrist, axillae, waistline, nipples in females and genitalia in males and umbilicus * Treated via medication Implications for the PTA * Prevention of transmission * Gloves, gowns, & hand washing * Single use BP cuffs * Thorough disinfection of equipment

Answer 232

Hep B Flu COVID MMR Measles TDAP: Tetnus, DPtheria Varicella (Chicken Pox)

Answer 233

* Esophagitis * Which may be a result of reflux of infectious agents, chemical irritants, physical agents, or gastric juices * Acid flowing backward from the stomach * Reflux esophagitis is most common type * Wide range of foods and lifestyle factors contribute * Heartburn, reflux, belching, dysphagia, and painful swallowing * Pain may radiate to the back, neck or jaw * Often occurs 30-60 minutes after a meal

Answer 234

Medications * Acid suppressing inhibitors (Proton Pump Inhibitors) -meds ending in prazole: Esomeprazole(Nexium), omeprazole(Prilosec) * OTC drugs usually help to block the histamine or neutralize stomach acid -meds ending in tidine: cimetidine(Tagament), Famotidine(Pepsid), Rantidine(Zantac), Maalox, Mylanta

Answer 235

* Lifestyle Modifications * Wearing loose clothing * Avoiding caffeine, nicotine, alcohol, NSAIDS and ASA (aspirin) * Avoiding meals near bedtime or naptime * Elevation of bed at night, Sleep on Left side at night * Remain upright 3 hours after a meal * Avoid large meals

Answer 236

* Exercise is important especially for those overweight * Exercise may worsen symptoms * Strenuous exercise can inhibit gastric & sm. intestine emptying * Positioning * Take care when implementing interventions in supine position * Encourage LEFT sidelying or head-elevated positions

Answer 237

* Inflammatory Bowel Disease * Chronic lifelong inflammatory disorder * Can affect any segment of the intestinal tract * Characterized by diseased areas * Periods of exacerbation & remission *Bi-polar colon disorder with periods of diarrhea and constipation. Clinical Manifestations * Begins with low grade fever, malaise, weight loss, diarrhea & abdominal cramping or pain * Followed by an obstructive phase with persistent bloating and distention

Answer 238

* Understanding the pain may mimic other MS pains * Dehydration * Monitor for signs of dehydration (dry lips, hands, headache, disorientation) * Psychological impact of the disease and the patient's susceptibility to emotional stress * Stress management, relaxation techniques

Answer 239

* Description * Progressive liver disease that destroys liver cells * Fibrous scar tissue replaces cells * Liver functions deteriorate, damage is irreversible * Death can occur 5-15 years after diagnosis without transplant * Etiology * Chronic alcohol abuse * Viral hepatitis B and C * Autoimmune or metabolic diseases *important disease progression to know: - Ascites (fluid in peritoneal cavity)

Answer 240

* Physical therapy may be indicated for associated decreases in strength, endurance, mobility, and function. * Observe for fluid retention, ask about any changes in health status/weight gain * Prevent increased intra-abdominal pressure * Prevent injury from falls * Many patients with decreased aerobic capacity

Answer 241

All conditions related to the gallbladder * Cholelithiasis (gallstones created from cholesterol) * Choledocholithiasis (presence of gallstones in the bile duct. * Cholangitis (infection of the biliary [bile] tree) * Cholecytitis (inflammation of the gallbladder) * Cholecystectomy (surgical removal of the gallbladder)

Answer 242

* Cancerous * Can occur in the mouth, esophagus, stomach, liver, pancreas, colon

Answer 243

* Surgery moving one end of the large intestine through the abdomen * Stool drains into colostomy bag * Done after bowel obstruction or bowel resection

Answer 244

- Done for obesity 3 Options: * Lap Band * Roux-en-Y (bypass) - ‘gold standard’ * Vertical sleeve gastrectomy

Answer 245

* Bands are placed around the stomach * Fastened around the upper portion of the stomach * Limits & controls the amount of food you eat * Slows the emptying process Pros * Least traumatic * Reversible * Adjustable * No dumping syndrome (happens when food, especially sugary food, moves too quickly from the stomach to the small intestine, causing cramping, diarrhea, nausea (early symptoms 10-30 mins after eating), or weakness, shakiness, and rapid heartbeat (late symptoms 1-3 hrs after eating) due to blood sugar shifts) Cons * Slower initial weight loss * Regular f/u required for optimal results * Can have band slippage

Answer 246

* Creates a smaller stomach pouch * The attaches a y shaped section of the small intestine to the large intestine * Bypassing much of the small intestine Pros * Gold Standard * Rapid Weight loss * Reduction in weight related health concerns Cons * Complex operation * Not reversible * Risk of intestinal leaking * Deficiency in mineral absorption

Answer 247

* Mostly done for those too heavy to have the other 2 options * The structure of the stomach is changed * Now shaped like a tube * Restricts amount of calories ingested * 75-80% of the stomach is excised Pros * Rapid weight loss * Portion of stomach producing hunger hormones is removed * Limited stomach expansion * Reduced risk of vitamin deficiency Cons * Not reversible * May be considered investigational by some insurance companies

Answer 248

In the cochlea ◦ Essentially the organ of hearing ◦ Contains 2 types of receptors cells  Inner and outer hair cells ◦ Inner hair cells  Function as auditory receptor cells ◦ Frequency dependent

Answer 249

 Vestibule ◦ Contains 2 swellings (these needed for balance)  Utricle for horizontal plane movement  Saccule head position with respect to gravity  Otoconia ◦ The inertia of the otoconia causes the gel to lag behind the movement of the skull and bends the hair cells.

Answer 250

 Innervation provided by CN VIII ◦ Vestibular portion -> balance information  Analyzes information about the position or movement of the head in space  Functions ◦ Maintain balance ◦ Coordinates eye, head and body  Semicircular Canals ◦ 3 anterior, posterior and lateral ◦ Arranged in 3 planes ◦ Lie roughly at right angles to each other ◦ Ampulla  Enlargement at the base of each canal  Cupula resides with in the ampulla  Lymph lags behind and activates or deactivates the cupula

Answer 251

Area highly condensed cones

Answer 252

Area where the optic nerve and blood vessels enter and leave the eye

Answer 253

Contains the photoreceptors  Rods mediate light perception ◦ The image on the retina is inverted and reversed

Answer 254

From the eye to the chiasm Cranial Nerve II (purely sensory - no motor function)

Answer 255

the crossing of nerve fibers at front of head. an X-shaped neural structure at the base of the brain, located below the hypothalamus and just above the pituitary gland, where the optic nerves partially intersect PPT 8 Special Sensory Disorder slide 23* A - Optic nerve damage B - D -

Answer 256

Prior to interaction with the lateral geniculate nucleus

Answer 257

 Light Reflexes ◦ Light causes the pupil to contract  Convergence ◦ Eyes move toward the midline so the image remains focused on the fovea  Accommodation ◦ Increasing the thickness of the lens to maintain focus on the fovea  Pupillary constriction ◦ To regulate the depth of the focus

Answer 258

 It is a cloudy or opaque area of the lens of the eye  Usually develops slowly  Most common cause of age related vision loss  Progressively reduced visual acuity  Blurring  Photosensitivity  The pupil appears white, opaque in appearance

Answer 259

 Defined as damage to the optic nerve due to increased intraocular pressure  Common severe condition

Answer 260

 A progressive deterioration of the macula of the retina  Destructive changes of the yellow pigmented area surrounding the central fovea (central vision)

Answer 261

 An involuntary constant movement of the eyes that is visible to others  Can affect one or both eyes  Movements can be in any direction - Variety of causes: tumors, alcohol abuse (too much to drink - not long term usage), congenital, head trauma, other diseases.

Answer 262

 Loss of half of the visual field  Classified by the missing field ◦ Homonymous (same half of each field)  Ranges from mild to severe ◦ Which portions of the visual pathways are damaged  Causes include: ◦ Stroke ◦ Trauma ◦ Tumors ◦ Seizures, migraines ◦ Infections ◦ Toxin exposure

Answer 263

Ringing or buzzing in the ears Cranial Nerve 8 - VestibuCochlear  Caused by: ◦ Vascular abnormalities ◦ Medications ◦ Stimulants (caffeine or nicotine)  It is actually a symptom  Treatment is focused on decreasing symptoms rather than a cure  Implications for the PTA ◦ Difficulty concentrating or hearing

Answer 264

Type of vertigo: Benign Paroxysmal Positional Vertigo (BPPV)  Episodic intense vertigo related to head position  Benign because it is NOT the sign of disease process but a mechanical disorder of the labyrinths Most common cause of vertigo  Increased fluid pressure within the labyrinth may dislodge the otoconia  Head trauma or infection may also be responsible ◦ Preceding by months or years *NOT the kind of patient you want to sit up if dizzy  Common Characteristics ◦ Episodic sensation of intense vertigo with head position changes ◦ Sensation stops after 20-30 sec in static position ◦ Nausea w/vertigo w/reports of spinning inside the head ◦ Autonomic changes such as sweating, feeling like passing out  Common Characteristics Con’t ◦ Sensation of movement of the environment and blurred vision ◦ Reports of disequilibrium during typical activities ◦ Waking up dizzy at night after rolling over in bed ◦ Symptoms during head movement or bending forward during typical activities *Dix Hallpike Maneuver - Special Test - Beginning of Epley's or Semont maneuvers which is to treat it. - Also medications for vertigo - Or canalith repositioning - usually done by PT

Answer 265

 Endolymphatic hydrops ◦ Disorder relating the membranous inner ear due to an over accumulation of endolymph ◦ Most common syndrome ◦ Characterized by:  Episodic vertigo  Fluctuating hearing loss  Sensation of fullness in the ear  Tinnitus  Implications for the PTA ◦ Psychological issues because unpredictable attacks  Social phobias  Insecurities  Anxiety

Answer 266

◦ Diseases of the blood vessels (arteries and veins) supplying the extremities  Typically affects the LEs > UEs  Most commonly a result of atherosclerosis  May be a side effect of atherosclerosis to the arteries supplying abdominal organs ◦ Atherosclerosis of the peripheral arteries ◦ Diabetes, cigarette smoking, hypertension, hyperlipidemia, gender (males) ◦ Inflammatory disorders, vasculitis  Hypertension, reduced urine output, kidney damage  Ischemia of both large and small intestines  Gastrointestinal symptoms  Intermittent claudication* ◦ Classic symptom of PAD, generally occurs in calves [No pain, no gain - gotta push them to max tolerable pain] ◦ If pain at rest = more severe  Gangrene

Answer 267

Treatment  Prevention – reduce risk factors  Angioplasty  Bypass surgery  Medications ◦ Statins (cholesterol lowering) ◦ Antiplatelet drugs (decrease risk for thrombus formation/clotting)- low dose aspirin  Amputation PT Interventions  Treatment of arterial insufficiency disorders ◦ Arterial insufficiency ulcers, gangrene  Monitor pain with exercise  Do NOT heat area or perform massage  Positioning, Buerger-Allen exercises ◦ pain will likely ↑ with legs elevated  Exercise programs ◦ Graded treadmill protocols  Skin inspection  NO constrictive or compressive garments  **Interventions will differ for venous disorders  ABI (Ankle Brachial Index) - comparison of BP in arm and ankle to check for PVD).

Answer 268

◦ Periodic temporary, severe, arterial vasospasms in superficial tissues causing pallor/cyanosis of digits in response to cold temperature S & Sx:  Skin turns blue to white to red  Cyanosis, numbness and sensation of cold  Signifies ischemia  As circulation is restored ◦ Affected area turns purplish red followed by pain  Skin may ulcerate

Answer 269

Partial occlusion or complete occlusion of a VEIN by a thrombus (clot) with 2⁰ inflammatory reaction in the wall of the vein If clot breaks free it goes up veins (which get bigger as they go towards the heart) and can cause a pulmonary embolism Special Test: Homan's sign - pain in calf when ankle dorsiflexed passively > test no longer considered sensitive and specific to rule a DVT in or out.

Answer 270

Heparin ◦ Measured by Partial Thromboplastin Time (PTT)  A blood test that looks at how long it takes for blood to clot ◦ Usually normal 24 hours after initiated ◦ Low Molecular Weight Heparin (LMWH) Coumadin ◦ Measured by International Normalized Ratio (INR)  A calculation used to monitor individuals who are being treated with the blood-thinning medication - *If it clots too quickly you need more medication, if it's too fast you need less

Answer 271

◦ Abnormal dilation of veins from incompetent valves ◦ Superficial or deep veins affected ◦ Legs, esophagus, rectum ◦ Blood flow is turbulent and slow favoring clotting which can lead to thrombus formation ◦ Spider veins Signs and Symptoms ◦ Symptoms develop gradually  Fatigue or ache in the legs at the end of the day, ankles may swell, leg cramping at night ◦ Condition progresses  Veins appear bluish-purple, bulbous and tortuous, hard to the touch, pain worsens and is noted earlier in the day  Ulcers may form near the ankle

Answer 272

 **Blood sugar levels decrease with insulin and with exercise. Avoid treatment shortly after insulin is given or before eating**  Hypoglycemia ◦ 70 mg/dL or less ◦ s/s: blurred vision, fatigue, pale skin, HA, hunger, shaking, sweating, trouble concentrating, loss of consciousness - "Did you take your insulin right before therapy?" - If they did you need to monitor them as insulin will reduce blood sugar.  Diabetic Ketoacidosis (DKA) [Very high hyperglycemia] ◦ >300 mg/dL ◦ s/s: flushed, thirsty, fruity breath, rapid breathing, abdominal pain, vomiting, confusion *Both hypo and hyperglycemia can lead to coma and death

Answer 273

- ability of blood to carry oxygen ◦ Erythrocytes ◦Decreased:  Anemia, blood loss, dietary insufficiency, chemotherapy, various disorders and diseases ◦Increased:  Polycythemia vera (disorder bone marrow), dehydration, severe diarrhea, poisoning, high altitude, chronic heart disease

Answer 274

cells that fight infection ◦ Leukocytes ◦Decreased:  Infection, bone marrow suppression or failure, AIDS, alcoholism, diabetes, autoimmune disease ◦Increased:  Indicates infection, inflammation, tissue necrosis, leukemia, tissue trauma or stress, burns, dehydration  <1000/mm3 No exercise; wear protective mask*  <5000/mm3 No exercise permitted  4800-10,800 mm3 normal range in adults  no activity restrictions  >5000 mm3 Light exercise, progress as tolerated - Too high - also don't exercise

Answer 275

◦ Hematocrit (HCT)  Is a PERCENTAGE of whole blood occupied by RBCs ◦ Normal range for adults ◦ Hemoglobin (HgB)  Measures oxygen carrying capacity of RBCs - DIRECT COUNT of RBCs ◦ Normal range for adults Exercise Guidelines ◦ Hematocrit  <25% No exercise permitted  >25% Light exercise permitted  30-32% Add resistive exercise ◦ Hemoglobin  <8 g/dL No exercise permitted  8-10 g/dL Light exercise permitted  >10 g/dL Resistive exercise permitted

Answer 276

Clotting potential ◦ Decreased  Anemia, use of antibiotics, toxic effect of many drugs, pneumonia or other infections, HIV infection, cancer, chemo, bone marrow replacement ◦ Increased  Inflammation, infection, cancer, splenectomy, trauma, RA, heart disease, cirrhosis, recovery from bone marrow suppression

Answer 277

Molecule specific to muscle tissue & is specific to myocardial injury * If Troponin levels are elevated we are not allowed to do cardio

Answer 278

When body runs out of energy stores and the body breaks down skeletal muscle tissue for energy.

Answer 279

pH Measure of blood acidity (acidic< [7.35-7.45 > alkaline)]

Answer 280

increase in white cell count/reduction of white cell count

Answer 281

increase in red blood cells

Answer 282

reduced number of platelets

Answer 283

3 Layers: Epidermis Dermis Hypodermis

Answer 284

Regeneration  Replacement of destroyed tissue by the same kind of cells Fibrosis  Repair by dense fibrous connective tissue (scar tissue) Determination of method  Type of tissue damaged  Severity of the injury

Answer 285

Capillaries become very permeable  Introduce clotting proteins  Wall off injured area from bacteria and other harmful substances  Scar – clot was exposed to the air and dries Formation of granulation tissue  New capillaries form delicate pink tissue  Contains phagocytes and fibroblasts (building blocks)  New collagen fibers are formed (scar tissue) Regeneration of surface epithelium

Answer 286

Stage 1: Skin is unbroken but inflammed Stage 2: Skin is broken to epidermis or dermis Stage 3: Ulcer extends to subcutaneous fat layer Stage 4: Ulcer extends to muscle or bone. - Undermining is likely.

Answer 287

Risk scale for Pressure Ulcers Factors: - Mobility - Activity - Sensory Perception - Moisture - Friction-Shear - Nutrition - Tissue Perfusion and Oxygenation

Answer 288

Venous Ulcers - Occur due to impaired venous circulation Etiology  Trauma, varicose veins, thrombosis occur and impair the venous return system  Risk factors include heart disease, DVT, obesity, genetic defects of valves Signs and Symptoms  Irregular shape, on lower leg  Yellow, white, gray, but not black (as in arterial ulcers), exudate (a mass of cells and fluid that has seeped out of blood vessels or an organ)  Edema and cellulitis can also be present Treatment  Debridement  Surgery

Answer 289

 Ischemic ulcer, diabetic ulcer  Seen with peripheral vascular disease and diabetes Etiology  Reduction in oxygenation perfusion of tissue -> lack of oxygenated blood to skin, muscles, other tissues -> gangrene and ischemic ulcers  Risk factors are heredity, smoking, high blood pressure, diabetes mellitus, hypercholesterolemia, atherosclerosis, peripheral neuropathy, reduced joint range of motion, obesity, poor footwear Signs and Symptoms  Absence of arterial pulses, night pain, absence of hair, pallor when elevated  Circular shape, “punched out”  Rarely bleed, slow or fail to heal  Necrotic tissue, black eschar Treatment  Surgery  Hyperbaric oxygen therapy (HBOT)  Debridement of necrotic tissue  Dietary and lifestyle changes  Possible amputation

Answer 290

Results from the simultaneous action of many contributing factors  Peripheral neuropathy -60% of ulcers due to lack of sensation  Peripheral vascular disease - 50% of the cases there is some vascular limitations

Answer 291

 Arises in basal layer of epidermis  Most common form  Least dangerous due to slow growth - Does not easily invade blood or lymph vessels  If untreated, can invade other tissues Risk factors  Excessive exposure to sunlight (natural or artificial)  Fair skin and light-colored hair and eyes  Personal or family history of skin cancer, past radiation treatments, immunosuppression, chronic exposure to arsenic Signs and Symptoms  Elevated, firm nodule  Pearly or ivory white with central depression  Painless  As progresses – more prominent, bleed, form crusts

Answer 292

 Second most common form of skin cancer  More prevalent in those > 50 years old  Men > women; 3:1  95% curable when detected early  History of excessive exposure to sunlight (natural or artificial)  Fair skin, light-colored hair and eyes  Personal or family history of skin cancer, past radiation treatments, immunosuppression, chronic exposure to arsenic, smoking, chewing tobacco Signs and Symptoms  Irregular borders that develop ulcerated center  Thickened, rough, crusted, may bleed  Usually on face, neck, scalp, ears, lips, shoulders, arms, upper back and trunk  In the mouth – red or ulcerated sore or white patch

Answer 293

 Develops from melanocytes in basal layer of the epidermis or from benign melanocytic mole (nevus)  Extremely malignant, grows quickly, extending down to tissues, metastasizes to regional lymph nodes and other organs  Accounts for 74% of deaths from skin cancer  May develop from a preexisting nevus or appear as new in normal skin  Exposure to UV radiation, history of severe sunburn (especially during childhood)  Fair skin, light-colored hair and eyes  Multiple moles  Family history  Older age Signs and Symptoms  Lentigo melanoma, superficial spreading melanoma, nodular melanoma  Skin lesions with mixed flat and raised portions, irregular shape, dark brown or black lesions, variations of color, itching, mole > 6 mm diameter, bleeding from lesion  Lesion with above characteristics may suddenly appear

Answer 294

 Malignant, rare, seen in patients that have AIDS (secondary opportunistic infection)  Originates in blood vessels and connective tissue of dermis; mouth, nose, throat, and other linings Etiology  Kaposi’s sarcoma-associated herpes virus (KSHV) in patient’s with HIV  Corticosteroids and immunosuppressive medications

Answer 295

 Wound care may be indicated after surgical removal  May be able to identify possible cancerous sites on skin  Important for early detection  Improve chances for survival  Strengthening, ambulation, endurance, and mobility, especially in patients with AIDS and Kaposi’s sarcoma

Answer 296

Stage 1, 2, 3,4 - Pressure ulcers. Others cannot be staged like this. Burn degrees are not "stages"

Answer 297

1st Degree (Superficial) Burn  Previously called “first – degree”  Only epidermis is damaged  Red, swollen, tender  Healing in only a few days  Sunburn 2nd Degree (Superficial partial-thickness) Burn  Previously called “second-degree”  Epidermis and upper dermis are damaged  Swelling, redness, blistering, pain  Healing in 10 days – regrowth may occur because epithelial cells are still present  Minimal scarring may form 3rd Degree (Deep partial thickness) Burn  Previously called “third degree”  Damage to epidermis and dermis to reticular layer  Blood vessels, hair follicles and sweat glands  Red, white severe edema, heal in 3-5 weeks  Keloid and hypertrophic scarring 4th Degree Type I (Full-thickness) Burn  Previously called “fourth degree”  Destroys entire skin layers, down to fat tissue  Eschar, leathery, numb (damage to nerve endings)  Damage to lymphatic vessels (little swelling seen)  Requires skin-grafting  Healing several months  Regeneration not possible (Full-thickness) Burn 4th Degree Type II (Sub-dermal) Burn  Also previously called “fourth degree”  Destroys entire skin layers, including fat, muscle, bone  Caused by flame or electrical shock  Require surgery, skin grafting, possible amputation  Can be lethal

Answer 298

Hypertrophic  Excess collagen production  Raised  Do not grow beyond boundaries of original scar Keloid  Excess collagen production  Raised  Extend beyond wound site

Answer 299

 Current passes through body through blood vessels and nerves  Line of least resistance  Extensive damage to blood vessels, heart, kidneys, nerves  Gangrene and spinal cord damage  Not immediately evident

Answer 300

 Way to determine the extent of burns  Body is divided into 11 areas for quick estimation  Each area represents about 9% Weaker degree burns can still be dangerous if they cover enough of the body. Totals: - Anterior and posterior head and neck, 9% - Anterior and Posterior UEs, 18% (9% each limb) - Anterior and Posterior trunk, 36% (18% each side) - Perineum, 1% - Anterior and Posterior LEs, 36% (18% each limb)

Answer 301

 Infection  Cardiac arrest  Smoke inhalation (smoke isn't just dirty, can also be hot enough to burn lungs)  Inhalation of noxious chemicals  Pneumonia  Hypothermia  Scarring

Answer 302

In other words, the severity level of the burn can trump the size of the area burned.

Answer 303

 Sharp debridement by PT (necrotic tissue)/Non-sharp debridement PTAs can do, whirlpool, pulsed lavage, dressing changes  Prevention of deformity through stretching and range of motion  Precautions for maintaining sterile environment, disturbing skin graft  Prevention of atrophy through cardiovascular exercises *Position patient away from position of the burn. Ex) Right side of neck burn means neck shouldn't be placed in right side flexion.

Answer 304

 Also called erysipelas, necrotizing fasciitis (severe)  Infection and inflammation of the skin and subcutaneous tissues  If left untreated can spread to blood and become systemic  Higher incidence with chronic diseases and conditions  Etiology  Strep and Staph  MRSA Cellulitis & Necrotizing Fasciitis - Necrotizing fasciitis is a serious bacterial infection that spreads rapidly and destroys the body's soft tissue. - Commonly called a "flesh-eating infection" by the media, this rare disease can be caused by more than one type of bacteria. These include group A Streptococcus (group A strep), Klebsiella, Clostridium, E. coli, Staphylococcus aureus

Answer 305

 Thermal Injury  Overexposure to the cold air or water  2 major forms  Localized injuries (frostbite)  Systemic injuries (hypothermia)  Initial vasoconstriction in the skin to protect the core  When tissue temps drop below 35.6° F - Ice crystals form in the tissues and expand extracellular spaces - With compression of cells, cell membrane rupture, interrupting enzymatic and metabolic activities

Answer 306

Hemorrhage -Loss of a large amount of blood in a short period, externally or internally.  Hemorrhage may be arterial, venous, or capillary Contusion - A bruise; an injury with no break in the skin, characterized by discoloration, pain, and swelling Ecchymosis  Skin discoloration consisting of a large, irregularly formed hemorrhagic area with colors changing from blue-black to greenish brown or yellow; commonly called a bruise Petechia - Minute, pinpoint hemorrhagic spot of the skin.  A petechia is a smaller version of an ecchymosis

Answer 307

- Blood loss into a tissue, organ or other confined space. - Elevated, localized collection of blood trapped under the skin that usually results from trauma

Answer 308

* Acid-base balance in the blood * Blood pressure regulation - Production of renin (enzyme) - Increase volume → increase BP * Red blood cell production - Stimulated by erythropoietin * Activation and conversion of vitamin D * Storage and transportation of urine - Ureters, urinary bladder, urethra - Blood Pressure Fall in BP > Release of Renin > Release of Angiotensinogen (Angiotensinogen/Angiotensinogen I/Angiotensinogen II) > Vasoconstriction or Aldosterone Release > BP increase or Sodium retention leading to BP increase.

Answer 309

Failure of the kidneys to perform their physiologic functions adequately Acute renal failure * Abrupt, sudden reduction in renal function * If untreated, renal functions cease within a couple weeks Chronic renal failure (end stage renal disease) * Insidious and gradual, irreversible * Accompanied by dysfunction of other organs * Renal failure – significant loss of function * Renal insufficiency – diminished to 25% of normal function * Uremia – accumulation of waste products in the blood Signs and Symptoms * General malaise and weakness; progressing to severe fatigue * Changes in mental status * Oliguria (urinating a lot), anuria (inability to urinate) * Weight loss * Edema * Sensation loss in hands and feet * Severe bruising * Anemia * Malnutrition * Renal bone disease from dysfunction of platelets

Answer 310

Cystitis (Bladder Infection) Pyelonephritis (Kidney Infection) * UTIs affect more than 11.3 million women per year * 5-30% of the older adult population * Mostly in females * Urethra is shorter and closer to the entrances of the rectum and vagina * Bacteria that result in most UTIs are acquired from the large bowel * Catheterization * Accounts for 40% of nosocomial infections * *Most common cause is "holding it in" for too long/too much Clinical Manifestations * Frequency * Urgency * Dysuria (peeing at night) * Nocturia * Fever, chills, & malaise * Increased confusion among the elderly Implications for the PTA * May not be able to fully participate depending on the severity of the infections * Note any changes in mental status * Awareness of symptoms to educate on early recognition * At risk for infections elsewhere * Catheters should not be place on floor * Urinary retention is a risk factors for UTI, so assist patient to bathroom as necessary

Answer 311

Endocrine  Ductless glands  Anterior pituitary, thyroid, adrenals, parathyroid  Hormones released into blood Exocrine  Release products into body’s surface or cavities through ducts

Answer 312

 Underactive thyroid gland leading to deficiency of thyroid hormone secretion in adulthood  Cretinism, Hashimoto’s disease, congenital aplasia, secondary and tertiary Signs and Symptoms  Myxedema (Gull’s disease) = edema, obesity, intolerance to cold, decreased energy  Slowed metabolic rate, slowed mental processes  Muscle weakness  Thinning hair or hair loss

Answer 313

 Lack of production of insulin by pancreas [Type I]; inability of the body to utilize insulin [Type II] Type I diabetes: insulin dependent  Most often seen in children  Autoimmune with a genetic component Type II diabetes: non-insulin dependent (NIDDM) - Having high blood sugar levels more often that you should  Most common  Most often seen in adults, and in certain ethnic populations - African- or Asian- Americans, Pacific Islanders, Latin descent - > 45 years of age, sedentary, hypertension, high cholesterol, poor diet, obesity Blood Glucose Levels: Fasting Plasma Glucose - Normal: <100 mg/dL - Prediabetes: 100-125 mg/dL - Diabetes: >125 mg/dL 2 Hr Oral Glucose Tolerance Test - Normal: <139 mg/dL - Prediabetes: 140-199 mg/dL - Diabetes ≥200 mg/dL Signs and Symptoms  Occur suddenly and more severely in Type 1; more gradually in Type 2  Glucose in urine  Blurred vision  Weight loss, increased appetite  Nausea, vomiting, abdominal pain  Amenorrhea, erectile dysfunction  *3 P's of Diabetes - Polyuria - excessive or an abnormally large production or passage of urine - Polydipsia - excessive thirst - Polyphagia - excessive hunger

Answer 314

 Diabetic coma - Can result from both hyperglycemia and hypoglycemia  Bone disease - Osteoporosis  Cardiac and vascular diseases - Cerebrovascular disease, ischemic changes in the limb, renal disease, reflex sympathetic dystrophy, Dupuytren’s contracture, limited joint mobility, gangrene to extremities  Renal disease - Reduced function to kidneys  Eye problems - Glaucoma, retinopathy, cataracts  Diabetic amyotrophy - Proximal muscle weakness  Diabetic neuropathy - Foot drop, susceptible to injury due to loss of sensation to the skin, “stocking” or “glove” parasthesias, carpel tunnel syndrome, Charcot’s joint * complication of diabetes-related neuropathy (nerve damage). It can cause serious symptoms like fractures and ulcers (convexity in the arch of the foot picture)

Answer 315

 Exercise programs to improve blood pressure, weight loss, decrease heart rate and cholesterol levels, help body utilize insulin  Orthotic assessment, wound care for ulcers  Strengthening and lengthening of ankle musculature  Modalities to decrease pain  Rehabilitation for amputations  Pay particular attention to medication compliance  Sensory testing and patient foot care and inspection

Pathology Terms Flashcards

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