Term
| Impairments associated with PCS (5) |
|
Definition
impaired postural control/dizziness
headaches
exercise intoelrance
cognitive deficits
emotional distress/anxiety |
|
|
Term
| Impaired postural control/dizziness as a result of PNS can be a result of what (2) |
|
Definition
peripheral input
central integration |
|
|
Term
| Impaired postural control/dizziness as a result of PCS can be a result of what peripheral inputs (4) |
|
Definition
vestibular
proprioceptive (including cervical)
visual |
|
|
Term
| impaired postural control/dizziness as a reuslt of PCS due to central integration can be due to what |
|
Definition
| complex connections to/from various systems that are interpreted in the brain to generate response |
|
|
Term
| 4 types of peripheral vestibular disorders related to PCS |
|
Definition
BPPV
labyrinthine concussion
Temporal bone fx (post traumatic hydrosp)
perilymphatic fistula |
|
|
Term
| How could PCS result in BPPV |
|
Definition
| head injury of whiplash causes otoconia to be displaced |
|
|
Term
| how many cases of BPPV present with posterior canal BPPV secondary to anatomical structuring |
|
Definition
|
|
Term
|
Definition
| room spinning vertigo with positional changes that last for short periods of time (2 mins) |
|
|
Term
| What happens as a result of labyrinthine concussion? |
|
Definition
| membranous structures concussed against bony |
|
|
Term
| pathology associated with labyrinthien concussion |
|
Definition
| no structural or bony pathology |
|
|
Term
| labyrinthine concussion and the effct on the vestibular system |
|
Definition
|
|
Term
| vestibular hypofunctioning as a result of labyrinthine concussion is a result of what |
|
Definition
| from swelling/inflammation around vestibular nerve |
|
|
Term
| symptoms of labyrinthine concussion |
|
Definition
| causes severe acute veritgo intially with nystagmus that follows Alexander's law |
|
|
Term
| After the brain adapts to labyrinthine concussion what will this present as |
|
Definition
| vestibular hypofunctioning |
|
|
Term
| 95% of temporal bone fx cases have these symptoms |
|
Definition
| vestibular/auditory symptoms |
|
|
Term
| Temporal bone fx: if this nerve is transected or avulsed there is no vertigo |
|
Definition
|
|
Term
| Temporal bone fx: damage associated with this fx (4) |
|
Definition
damage to vestibular labyrinth structures
tympanic membrane tear
sensorineural hearing loss
facial nerve injury |
|
|
Term
| Temporal bone fx: my exist with what other peripheral vestibular disorders (3) |
|
Definition
BPPV
perilymphatic fistula
post-traumatic hydrops |
|
|
Term
| Temporal bone fx: causes severe acute vertigo with which other potential symptom and is similar to what other condition |
|
Definition
Nystagmus can be present
similar to labyrinthine concussion |
|
|
Term
| Post-traumatic (secondary hydrops): length of time to present |
|
Definition
| may present months to years after injury |
|
|
Term
| Post-traumatic (secondary hydrops): what is it? |
|
Definition
| abnormal fluctuations in endolymph which results in a swelling or distension of the endolymphatic spaces causing pressure on delicate structures |
|
|
Term
| Post-traumatic (secondary hydrops): symptoms (7) |
|
Definition
fluctuating hearing loss
tinnitus
aural fullness
episodic vertigo
ataxia
nausea
vomiting |
|
|
Term
| Post-traumatic (secondary hydrops): how is it managed (2) |
|
Definition
like Meniere's with diuretics
dietary salt restriction |
|
|
Term
| Perilymphatic fistula: what is it |
|
Definition
| rupture of round or oval windows that separate inner and middle ear with perilymph moving from inner ear that enters the middle ear |
|
|
Term
| Perilymphatic fistula: symptoms (3) |
|
Definition
vertigo
hearing loss
symptoms may fluctuate with val salva |
|
|
Term
| Perilymphatic fistula: treatment |
|
Definition
suspected cases treated with bed rest 1-2 weeks
most heal spontaneously
surgery otherwise |
|
|
Term
| Cervicogenic Dizziness: what is it |
|
Definition
| dizziness/disequilbrium caused by anormal afferent activity from the neck |
|
|
Term
| Cervicogenic Dizziness: can be a result of what reflexive activity (3) |
|
Definition
cervico-ocular (COR)
Vestibulo-colic reflex (VCR)
Cervico-colic reflexes (CCR) |
|
|
Term
| Cervicogenic Dizziness: what is the cervico-ocular reflex |
|
Definition
| signals from neck afferents to vestibular nuclei causes eyes movements |
|
|
Term
| Cervicogenic Dizziness: what is vestibulo-colic reflex |
|
Definition
| vestibular signals relayed to neck muscles to stabilize head |
|
|
Term
| Cervicogenic Dizziness: what is the cervico-collic reflex |
|
Definition
aligns head with trunk position
impairments results in postural instability |
|
|
Term
| 3 parts of central integration |
|
Definition
|
|
Term
| Central integration: input (3) |
|
Definition
vestibular
visual
proprioceptive (including cervical) |
|
|
Term
| Central integration: brain (4) |
|
Definition
vestibular nuclei
vestibulospinal tracts
ocular motor nuclei
cerebellum/cortex |
|
|
Term
| Central integration: output (2) |
|
Definition
ocular reflex
postural control |
|
|
Term
| Concussion can affect what 2 systems |
|
Definition
|
|
Term
| Concussion: Cortical systems: (3) |
|
Definition
frontal lobe
temporal lobe
parietal lobe |
|
|
Term
| Concussion: Sub-Cortical systems: (4) |
|
Definition
hypothalamus
trigeminal system
basal ganglia
cerebellum |
|
|
Term
| Concussion: Cortical systems: Frontal lobe symptoms |
|
Definition
|
|
Term
| Concussion: Cortical systems: parietal lobe symptoms |
|
Definition
|
|
Term
| Concussion: Sub-cortical systems: Hypothalamus symptoms (5) |
|
Definition
change in thermoregulation
change in BP control
change in sleep patterns
change in sexual function
diabetes insipidus |
|
|
Term
| Concussion: Sub-cortical systems: trigeminal system symptoms (2) |
|
Definition
|
|
Term
| Concussion: Sub-cortical systems: basal ganglia symptoms |
|
Definition
|
|
Term
| Concussion: Sub-cortical systems: cerebellum |
|
Definition
| change in balance/posture |
|
|
Term
| Oculomotor dysfunction and PCS |
|
Definition
| oculomotor impairments can accurately predict protracted recovery |
|
|
Term
| PCS: What injury may result in impaired oculomotor function |
|
Definition
|
|
Term
| PCS: Oculomtor dysfunction: types (4) |
|
Definition
gaze holding nystagmus
smooth pursuit
saccades
convergece |
|
|
Term
| PCS: Oculomtor dysfunction: gaze holding nystagmus would indicate what |
|
Definition
| abnormalities may be central or peripheral |
|
|
Term
| PCS: Oculomtor dysfunction: smooth pursuit would indicate what |
|
Definition
| abnormalities may be seen with cerebellar or brain stem lesions |
|
|
Term
| PCS: Oculomtor dysfunction: saccades would indicate what |
|
Definition
| abnormalities are seen with cortical, brainstem, or cerebellar lesions |
|
|
Term
| PCS: Oculomtor dysfunction: convergence would indicate what |
|
Definition
| abnormalities are seen with brainstem |
|
|
Term
| PCS: Impaired Postural Control: specific components to balance (3) |
|
Definition
somatosensation
vision
vestibular |
|
|
Term
| PCS: Impaired Postural Control: functional limitations described by the patient (3) |
|
Definition
difficulty in the dark
shoes on/off
uneven surfaces |
|
|
Term
| PCS: Impaired Postural Control: beware of what types of balance strategies |
|
Definition
|
|
Term
| M-CTSIB: eyes open, feet on floor. Possible impairemnts if unsteady (2) |
|
Definition
poor gaze stabilization
lower extremity weakness |
|
|
Term
| M-CTSIB: eyes closed, feet on floor, possible impairments if unsteady (3) |
|
Definition
impaired sensation/proprioception
fear of falling
LE weakness |
|
|
Term
| M-CTSIB: eyes open, feet on foam. possible impairemnts if unsteady |
|
Definition
poor use of vision
impaired center of gravity control
LE weakness |
|
|
Term
| M-CTSIB: eyes closed, feet on foam impairemnts if unsteady (2) |
|
Definition
poor use of vestibular info
fear of falling |
|
|
Term
| 4 types of headaches after concussion |
|
Definition
cervicogenic (tension)
post traumatic migraine
dysautonomia
rebound headaches |
|
|
Term
| PCS: Headaches: Post traumatic migranine: result of what |
|
Definition
| trauma to the head or neck may trigger the migraine process in a susceptible indiviual who previously did not have migraine headaches |
|
|
Term
| PCS: Headaches: Post traumatic migranine: d/t what |
|
Definition
| neurotransmitter imbalance (spreading depression) |
|
|
Term
| PCS: Headaches: Post traumatic migranine: mgmt |
|
Definition
|
|
Term
| PCS: Headaches: Dysautonomia: what is it |
|
Definition
| autonomic nervous system malfunctions and can not keep intercranial pressure at desired level |
|
|
Term
| Cervical vs migraine: more dull sensation |
|
Definition
|
|
Term
| Cervical vs migraine: provoked with head movement or prolonged adverse positioning |
|
Definition
|
|
Term
| Cervical vs migraine: more likely to have upper arm/shoulder pain (upper trap) |
|
Definition
|
|
Term
| Cervical vs migraine: unilateral or bilateral |
|
Definition
|
|
Term
| Cervical vs migraine: around orbit |
|
Definition
|
|
Term
| Cervical vs migraine: photo/phone sensitivity |
|
Definition
|
|
Term
| Cervical vs migraine: sharp/stabbing |
|
Definition
|
|
Term
| Cervical vs migraine: not usually localized posteriorly |
|
Definition
|
|
Term
| Cervical vs migraine: may be unilateral |
|
Definition
|
|
Term
| Cervical vs migraine: nausea |
|
Definition
|
|
Term
| What is space nd motion discomfort |
|
Definition
| uneasiness created by situational stimuli (heightened awareness of normal motion) |
|
|
Term
| space and motion discomfort co-exists frequently with what conditions (2) |
|
Definition
|
|
Term
| Problem presentation with space and motion discomfort |
|
Definition
walking in supermarket or crowded places
heights
wide open spaces
tunnels/bridges |
|
|
Term
| PCS: Exercise intolerance is due to waht |
|
Definition
| impaired ANS function results in altered systemic response to exercise |
|
|
Term
| PCS: Exercise intolerance: symptoms (5) |
|
Definition
dizziness
pressure in head/eyes
headache
filling in head
foggy head |
|
|
Term
| PCS: Exercise intolerance: cardiac function alteration (2) |
|
Definition
cardiac autonomic function is altered
HR response to submax ex is increased |
|
|
Term
| PCS: Impaired cognition: what is it |
|
Definition
| persistence of cognitive deficits will limit functional recovery even if physical symptoms are improving |
|
|
Term
| PCS: Neurocognitive testing: allows for what |
|
Definition
| more comprehensive understanding of status by revealing cognitive deficits in otherwise asymptomatic patients |
|
|
Term
| PCS: Neurocognitive testing: value |
|
Definition
| adds value in determining prognosis/severity of injury |
|
|
Term
| PCS: Neurocognitive testing: other considerations (2) |
|
Definition
helps with considerations for academic accomdodations
opportunity for dialogue with managing MD regarding potential referral |
|
|
Term
|
Definition
| demographic/concussion History questionnaire |
|
|
Term
| ImPACT has what 8 neurocognitive measure categories |
|
Definition
verbal memory
visual memory
reaction time
processing speed |
|
|
Term
| Diff dx of PCS includes what (4) emotional distress/anxiety conditions |
|
Definition
factitious disorder
anxiety disorder
chronic fatigue syndrome
chronic pain syndrome |
|
|
Term
| PCS: Predictors of protracted recovery: (11) |
|
Definition
age
migraine history
premorbid learning disability
repeat concussion
females
retrograde amnesia
anterograde amnesia
brief Loss of conciousness
fogginess
post-traumatic migraine
on field dizziness |
|
|
Term
| PCS: Predictors of protracted recovery: why age |
|
Definition
| occurence in child worse than adolescent |
|
|
Term
| PCS: Predictors of protracted recovery: why females |
|
Definition
neck strength
more prone to migraine |
|
|
Term
| PCS: Predictors of protracted recovery: retrograde amnesia, likelihood for poor outcome |
|
Definition
|
|
Term
| PCS: Predictors of protracted recovery: anterograde likelihood of poor outcome |
|
Definition
|
|
Term
| PCS: Predictors of protracted recovery: loss of concsciouness and outcomes |
|
Definition
|
|
Term
| PCS: Predictors of protracted recovery: fogginess linked to what |
|
Definition
|
|
Term
| PCS: Predictors of protracted recovery: post traumatic migraine how much more likely to have a protracted recovery |
|
Definition
|
|
Term
| PCS: Predictors of protracted recovery: best predictor of protracted recovery and pcs |
|
Definition
|
|
Term
| PCS: related to professional sports in what way |
|
Definition
| chronic traumatic encephalopathy |
|
|
Term
| how many concussions occur each year |
|
Definition
|
|
Term
| most commonly reported symptosm immediately following concussion fo rinjured athletes |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
slowed reaction time
sensitivity to light
slurred speech |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Leading causes of TBI from most to least |
|
Definition
Falls
unknown
struck by/against
MVA
assaults |
|
|
Term
|
Definition
mechanical shake of the brain from acceleration/deceleration forces resulting in
influx of ions through previously regulated ion channels along the axon
release of excitatory neurotransmitters at synapses further distorting homeostasis of neurons |
|
|
Term
| Neurophysiology of concussion: post traumatic ionic cellular changes results in what |
|
Definition
| mitochondrial calcium overloading |
|
|
Term
| Neurophysiology of concussion: post traumatic ioninc cellular change results in mitochondrial calcium overloading which results in what (2) |
|
Definition
produces further inner membrane permeability
dysfunctional mitochondria in the cell body, along the axon, and at the presynaptic terminal |
|
|
Term
| Neurophysiology of concussion: the damage can start within what time period and can persist for how long? |
|
Definition
1 minute after trauma
and can persist for 24-48 hours |
|
|
Term
| PCS: Neuronal damage can result in (3) |
|
Definition
decrease cerebral perfusion and impaired global brain metabolism
labyrinthine dysfunction
vestibulo ocular dysfunction |
|
|
Term
| Observed signs of concussion in athlete (10) |
|
Definition
appears dazed or stunned
is confused about assignment or position
forgets an instruction
unsure of game, score, or opponent
moves clumsily
answers questions slowly
loss of consciousness
shows mood, behavior, personality changes
can't recall events prior to hit/fall
can't recall events after hit/fall |
|
|
Term
| PCS: symptoms reported by athlete (10) |
|
Definition
headache/pressure in head
nausea/vomiting
balance problems/dizziness
double or blurry vision
sensitivity to light
sensitivity to noise
feeling sluggish, hazy, foggy, groggy
concentration or memory problems
confusion
does not feel right, feels down |
|
|
Term
| Common symptoms in PCS: 4 broad categories |
|
Definition
thinking/remembering
physical
emotional/mood
sleep |
|
|
Term
| Common symptoms in PCS: Thinking/remembering (4) |
|
Definition
difficulty thinking clearly
feeling slowed down
difficutly concentrating
difficulty remembering new info |
|
|
Term
| Common symptoms in PCS: Physical (7) |
|
Definition
headache
fuzzy/blurry vision
nausea or vomiting
dizziness
sensitivity to noise or light
balance problems
feeling tired, no energy |
|
|
Term
| Common symptoms in PCS: emotional/mood |
|
Definition
irritability
sadness
more emotional
nervousness or anxiety |
|
|
Term
| Common symptoms in PCS: sleep (3) |
|
Definition
sleeping more than usual
sleep less than usual
trouble falling asleep |
|
|
Term
| PCS and referral to PT for what reasons |
|
Definition
Physical
headache
fuzzy/blurry vision
nauseae or vomiting
dizziness
sensitivity to noise or light
balance problems
feeling tired
no energy |
|
|
Term
|
Definition
thinking/remembering
difficulty thinking clearly
feeling slowed down
difficulty concentrating
difficulty remembering new info |
|
|
Term
| PCS: PT Exam: potential areas of injury if: headache (2) |
|
Definition
| brain contusion or cervicogenic headache |
|
|
Term
| PCS: PT Exam: potential areas of injury if: fuzzy or blurry vision (6) |
|
Definition
|
|
Term
| PCS: PT Exam: potential areas of injury if: nausea/vomiting (2) |
|
Definition
|
|
Term
| PCS: PT Exam: potential areas of injury if: dizziness (3) |
|
Definition
vestibular system (labyrinth)
brainstem
cervical |
|
|
Term
| PCS: PT Exam: potential areas of injury if: senstiviity to noise or light (5) |
|
Definition
brain contusion
CN 8, 3, 4, 6 |
|
|
Term
| PCS: PT Exam: potential areas of injury if: balance (5) |
|
Definition
cerebellum
VOR
VST
balance integration
cervical |
|
|
Term
| PCS: PT Exam: potential areas of injury if: feeling tired, no energy (3) |
|
Definition
brain contusion (RF, mito)
diminished cerebral perfusion |
|
|
Term
| PCS: Balance dysfunction: systems potentially effected (4) |
|
Definition
musculoskeletal
somatosensory
vestibular system
visual |
|
|
Term
| PCS: Balance dysfunction: considerations for the musculoskeletal system |
|
Definition
adequate ROM and at least 3/5 str
ankle strategies |
|
|
Term
| PCS: Balance dysfunction: considerations for the somatosensory systems |
|
Definition
| propriocetive information to cerebellum and cortex from LE and cervical spine |
|
|
Term
| PCS: Balance dysfunction: vestibular system considerations |
|
Definition
| peripheral componetns and vestibular nuclei and pathways |
|
|
Term
| PCS: Balance dysfunction: visual system considerations |
|
Definition
| visual input to vestibular nuclei and within brainstem to cerebellum |
|
|
Term
| PCS Musculoskeletal system assessment |
|
Definition
assess strength and AROM of
core/trunk
UE
LE
Assess alignment |
|
|
Term
| Danger signs of concussion (10) |
|
Definition
headache that gets worse and does not go away
weakness, numbness or decreased coordination
repeated vomiting/nausea
slurred speech
drowsy, cannot be aroused
dilated pupil
convulsions/seizures
confusion (cannot recognize people/places)
increasingly confused, restless, or agitated
unusual behavior
LOC |
|
|
Term
| Potential consequences of concussion |
|
Definition
Progressive neurodegeneration
Chronic traumatic encephalopathy
Accelerated neurodegeneration
Increased risk of alzheimer's, parkinson's, and other motor neuron disease |
|
|
Term
| Potential consequences of concussion: pathology of CTE |
|
Definition
tau neurofibrillary and glial tangles
dystrophic neurites
microvascullopathy
myelinated axonopathy
neuroinflammation of white matter degeneration |
|
|
Term
| Potential consequences of concussion clinical presentation |
|
Definition
behavioral changes
executive dysfunction
memory deficits
cogntive deficits that progress over time |
|
|
Term
| Types of bresat cancer (5) |
|
Definition
ductal carcinoma in situ (DCIS)
Invasive Ductal carcinoma (IDC)
triple negative bresat cancer
inflammatory breast cancer
metastatic breast cancer |
|
|
Term
| Breast cancer: Ductal carcinoma in situ features (3) |
|
Definition
non invasive cancer where abnormal cells contained to the lining of the breast milk duct
stage 0
in situ indicates it is in the original place |
|
|
Term
| Breast cancer: invasive ductal carcinoma features (2) |
|
Definition
cancer cells have spread to other parts of the breast tissue
accounts for 80% of all breast cancer dx |
|
|
Term
| Breast cancer: Triple negative breast cancer features (6) |
|
Definition
3 most common receptors known to fuel breast cancer growth (estrogen, progesterone, HER-2/neugene) are not present
hormone tx are not effective
10-20% of dx
more likely to affect younger women
more aggressive and difficult to treat
more likely to spread and recur |
|
|
Term
| Breast cancer: inflammatory breast cancer features (5) |
|
Definition
aggressive and fast growing breast cancer where the cells invade the skin and lymph vessels.
NO distinct tumor
characterized by a rash that resembles an orange peel and nipple changes
Stage 3
all tx can be included |
|
|
Term
| Breast cancer: metastatic breast cancer features (3) |
|
Definition
cancer has spread to other parts of the body
stage 4
common sites include: brain, bones, lung, and liver |
|
|
Term
| Surgical procedures for lymph nodes (2) |
|
Definition
sentinel lymph node biopsy
axillary disecction |
|
|
Term
| sentinel lymph node biopsy features |
|
Definition
surgeon uses a radioacive tracer to track lymph flow from the affected bresat to the first lymph nodes in the chain
first nodes are removed for biopsy |
|
|
Term
| axillary dissection features (6) |
|
Definition
removal of one or more levels of the axillary lymph nodes
there are 3 levels of axillary nodes
Level 1: found in the lower under arm
level 2: beneath pec minor
level 3: found between top border of pec minor and the clavicle
as many as 30 lymph nodes in the axilla |
|
|
Term
|
Definition
removal of cancerous tissues plus a healthy margin
aka wide local incision/partial mastectomy |
|
|
Term
| simple (total) mastectomy features |
|
Definition
| removes the entire bresat, nipple, areola, but no lymph nodes or mm |
|
|
Term
|
Definition
simple (total)
modified radical
radical |
|
|
Term
| modified radical mastectomy features |
|
Definition
| removal of bresat, nipple, areola, and underlying lymph nodes |
|
|
Term
| radical mastectomy features |
|
Definition
breast, pec mm, and all lymph nodes removed.
rarely performed |
|
|
Term
| Reconstructions options (3) |
|
Definition
breast implant surgery
TRAM flap
Lat flap |
|
|
Term
| TRAM/Lat flap features (3) |
|
Definition
trasversus rectus abdominus myocutaneous flap
portion of the abdominal tissue (skin, adipose, and mm components and connective tissue) is transplanted from the lower abdomen to the breast site
donor site comes from the back and latt mm |
|
|
Term
| Chemotheraphy features (7) |
|
Definition
can be given before and/or after surgery
side effects (hair loss, nausea/vomiting, fatigue, SOB)
chemo brain - memory loss
bone loss - early onset osteoporosis
neuropathy (can be long term)
weight gain
medicaitons can be given to help mitigate side effects |
|
|
Term
| 2 types of hormone therapy |
|
Definition
|
|
Term
|
Definition
aromatase inhibitor
lowers the amount of estrogen in post menopausal women |
|
|
Term
| Arimidex hormone therapy features (3) |
|
Definition
used in reducing the return of early stage hormone receptor bresat cancer, and tx of advanced stage recetpor cancer
usually taken for 5 years
side ffects: fatigue, hot flashes, jt pain, bone pain, decreased bone density |
|
|
Term
|
Definition
| selective estrogen receptor modulator (SERM) |
|
|
Term
| Tamoxifen therapy features (4) |
|
Definition
blocks the effect of estrogen on breast tissue by attaching to the estrogen receptor
used to tx men and both pre/post menopausal women
in addition to tx can be used for high risk women who have not been dx yet
used for 5 years |
|
|
Term
| PT referral reasons for breast cancer (10) |
|
Definition
loss of ROM, flexibility
loss of strength and functional use of arm
postural changes
osteoporosis mgmt
scar mgmt
return to occupation mgmt
adhesive capsulitis
mitgation of long term effects
lymphedema
axillary web syndrome |
|
|
Term
| highest risk for lymphedema following what procedure |
|
Definition
| mastectomy with lymph node removal and radiation (45%) |
|
|
Term
| what is axillary web syndrome |
|
Definition
appears as a cord of tissue that starts in the axilla and continues to elbow
unknown origin
appears to be lymphovenous in nature |
|
|
Term
| inner core mm refers to what and what mm (5) |
|
Definition
refers to mm that provide a stabilizing function
respiratory diaphragm
TA
multifidi
pelvic floor |
|
|
Term
| stabilizing core refers to what and what mm (6) |
|
Definition
relate more to mvmt
erector spinae
abdominal obliques
rectus abdominus
latts
glut max |
|
|
Term
| Pelvic floor mm features (4) |
|
Definition
PFM have a crnial and caudal excursion
sensation and proprioceptive awareness are needed with both contraction and relaxation
PFM assists in stability of the SIJ, pubic symphysis, sacrococcygeal, lumbopelvic, and hip jts
critical in enabling effective load transfer from the LE to pelvis and spine |
|
|
Term
| 3 functinos of teh pelvic floor |
|
Definition
|
|
Term
| pelvic floor support function |
|
Definition
| "holds up" contents of the pelvis and provides structural support |
|
|
Term
| pelvic floor sphincteric function |
|
Definition
| allows for closure and opening of the vagina, urethra, and rectum |
|
|
Term
| What is urge incontinence |
|
Definition
complaint of involuntary urine loss accompanied by or immediately preceded by a strong desire to void
usually has triggers: cold, running water, key in teh door
key question: do you leak urine on your way to the toilet
treated with meds and behavior modification |
|
|
Term
| what is stress incontinence |
|
Definition
involuntary loss of urine with physical exertion
key question: do you leak urine when you cough or sneeze? do you leak urine when you exercise?
usually treated with pessary, meds, surgery |
|
|
Term
| Pelvic organ prolapse can include what structures ((4) |
|
Definition
anterior vaginal wall
posterior vaginall wall
uterus (cervix)
apex of the vagina (vaginal vault) |
|
|
Term
| Pelvic organ prolapse may be associated with what |
|
Definition
connective tissue laxity or weakness
loss of mm nerve, ligament, or fascial integrity |
|
|
Term
| pelvic organ prolapse risk factors |
|
Definition
child birth
surgery
chronic constipation
systemic disease |
|
|
Term
| common types of pelvic organ prolapse (4) |
|
Definition
cystocele (bladder)
urethrocele (urethra)
rectocele (rectum)
vaginal vault (vagina) |
|
|
Term
| symptoms of pelvic organ prolapse (8) |
|
Definition
vaginal bulging
pelvic pressure
bleeding
discharge
infections
low back pain
often better in gravity reduced positions
often more prominent with straining |
|
|
Term
| Pelvic Orgapn Prolapse and the PT |
|
Definition
re-establish coordination of the inner ocre with the outer core
behavioral techniques
diff dx for LBP and SIJ |
|
|
Term
| Systemic changes in pregnancy: reproductive: uterus capacity |
|
Definition
| increases from 10 mL to 5000 mL |
|
|
Term
| Systemic changes in pregnancy: reproductive: smooth muscle in uterus |
|
Definition
| will increase in fiber length and width |
|
|
Term
| Systemic changes in pregnancy: reproductive: irregular practice contractions |
|
Definition
| braxton-hicks contractions |
|
|
Term
| Systemic changes in pregnancy: reproductive: when do braxton hicks contractions occur |
|
Definition
| begin in second and increase in third trimester |
|
|
Term
| Systemic changes in pregnancy: reproductive: what happens to the cervix (2) |
|
Definition
blood flow increases
cervical glands cause a mucus plug |
|
|
Term
| Systemic changes in pregnancy: reproductive: vaginal changes |
|
Definition
distends d/t connective tissue softening
vaginal discharge increases d/t incresae glycogen |
|
|
Term
| Systemic changes in pregnancy: reproductive: hormonal changes |
|
Definition
| progestorone secretion becomes main job of the ovaries first 6-7 weeks of pregnancy |
|
|
Term
| Systemic changes in pregnancy: reproductive: breast changes |
|
Definition
increased vascularity
nipple changes
stretch marks
can increase 1 lb each |
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: heart |
|
Definition
moved upward, forward, towards the left
heart rate incresaes 20% by end of term |
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: total blood volume |
|
Definition
| increases 30 to 50% and blood plasma increases 40-60% |
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: cardiac output |
|
Definition
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: peripheral vascular resistance |
|
Definition
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: position |
|
Definition
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: O2 consumption |
|
Definition
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: respiratory volume |
|
Definition
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: tidal volume |
|
Definition
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: progesterone |
|
Definition
| relaxes smooth muscle in respiratory tract |
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: estrogen |
|
Definition
| increases mucus membrane vascularity in upper respiratory tract (nasal and sinus stuffiness and nose bleeds) |
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: diaphragm |
|
Definition
lifts 4 cm
movement increases |
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: lung volume |
|
Definition
|
|
Term
| Systemic changes in pregnancy: cardiovascular/respiratory: substernal angle |
|
Definition
|
|
Term
| Systemic changes in pregnancy: urinary/integumary: urinary frequency/urgency |
|
Definition
|
|
Term
| Systemic changes in pregnancy: urinary/integumary: common night symptom |
|
Definition
|
|
Term
| Systemic changes in pregnancy: urinary/integumary: bladder capacity |
|
Definition
| doubles secondary to smooth muscle changes |
|
|
Term
| Systemic changes in pregnancy: urinary/integumary: kidney and ureter |
|
Definition
| size and shape change secondary to progesterone |
|
|
Term
| Systemic changes in pregnancy: urinary/integumary: urinary change which can lead to infection |
|
Definition
| urinary stasis is more common and UTI's increase |
|
|
Term
| Systemic changes in pregnancy: urinary/integumary: circulation |
|
Definition
| increases with increased sweat and sebaceous gland activity |
|
|
Term
| Systemic changes in pregnancy: urinary/integumary: estrogen |
|
Definition
| causes blood vessel dilation |
|
|
Term
| Systemic changes in pregnancy: urinary/integumary: collage fiber |
|
Definition
| separation causes stretch marks |
|
|
Term
| Systemic changes in pregnancy: urinary/integumary: stretch marks symptoms |
|
Definition
|
|
Term
| Systemic changes in pregnancy: urinary/integumary: hair growth |
|
Definition
|
|
Term
| Systemic changes in pregnancy: musculoskeletal: calcium storage: why? |
|
Definition
| fetal demand for calcium increase |
|
|
Term
| Systemic changes in pregnancy: musculoskeletal: calcium storage: where? |
|
Definition
| absorption from intestine increases and more calcium is stored |
|
|
Term
| Systemic changes in pregnancy: musculoskeletal: calcium storage: how much calcium in 1st trimester |
|
Definition
|
|
Term
| Systemic changes in pregnancy: musculoskeletal: calcium storage: how much calcium at week 35? |
|
Definition
|
|
Term
| Systemic changes in pregnancy: musculoskeletal: calcium storage: increased risk of what and why? |
|
Definition
| osteoporosis during pregnancy in those who use corticosteroids or who smoke and drink alcohol |
|
|
Term
| Systemic changes in pregnancy: musculoskeletal: abdominal wall: |
|
Definition
abdominal mm stretch and are no longer in a mechanical position to create an effective contraction
diastasis recti can occur |
|
|
Term
| Systemic changes in pregnancy: musculoskeletal: postural changes: c spine |
|
Definition
|
|
Term
| Systemic changes in pregnancy: musculoskeletal: postural changes: t spine |
|
Definition
increased kyphosis
protracted scapulae |
|
|
Term
| Systemic changes in pregnancy: musculoskeletal: postural changes: L spine |
|
Definition
|
|
Term
| Systemic changes in pregnancy: musculoskeletal: postural changes: pelvis |
|
Definition
|
|
Term
| Systemic changes in pregnancy: musculoskeletal: postural changes: base of support |
|
Definition
|
|
Term
| Systemic changes in pregnancy: musculoskeletal: postural changes: LE |
|
Definition
increased Hip er
potential increased genu recurvatum
potential increased foot pronation |
|
|
Term
| Hormonal influences: human chorionic gonadotropin (hCG) |
|
Definition
produced early in pregnancy
stimulates corpus luteum to produce estrogen and progesterone until the placenta takes over |
|
|
Term
| Hormonal influences: estrogen |
|
Definition
stimultaes uterine growth
aids in developing ductal system in breasts
increases production up to 30x during pregnacy |
|
|
Term
| Hormonal influences: progesterone |
|
Definition
relaxes uterine smooth mm
prevents tissue rejection of the fetus
stimulates breast lobes and lobules
stimulates increased ventilation |
|
|
Term
| Hormonal influences: relaxin |
|
Definition
inhibits uterine activity
softens cervical connective tissue
relaxes pelvic jts |
|
|
Term
| current health weight gain recommendations for pregnancy |
|
Definition
|
|
Term
| Pregnancy: Upper quarter complaints |
|
Definition
ToS
carpal tunnel syndrome |
|
|
Term
| Pregnancy: TOS exam findings |
|
Definition
decreased radial pulses
reproduction of pain, numbness, or tingling |
|
|
Term
|
Definition
postural correction
ther ex to balance mm of the neck, upper back, chest, and 1st rib mobs |
|
|
Term
| Pregnancy: carpal tunnel presents when |
|
Definition
| late in pregnancy with increased swelling leading to symptoms |
|
|
Term
| Pregnancy: carpal tunnel syndrome test findings |
|
Definition
|
|
Term
| Pregnancy: carpal tunnel syndrome tx |
|
Definition
ergonomic education
splinting in neutral
massage
elevation |
|
|
Term
| Pregnancy: Spine complaitns (2) |
|
Definition
|
|
Term
| Pregnancy: spine complaints: headaches (3) |
|
Definition
postural changes
hormonal influences
postural education and manual treatments very helpful |
|
|
Term
| Pregnancy: spine complaints: neck pain |
|
Definition
forward head and rounded shoulder position d./t postural changes
motion testing is safe to do
continue with normal tx such as modalities, manual therapy, and ther ex |
|
|
Term
| Pregnancy: trunk complaints |
|
Definition
diastasis recti
abdominal mm dysfunction correlated with LBP
avoiding the val salva maneuver/increasing abdominal pressure
most tx occur in the post partum period |
|
|
Term
| Pregnancy: SI dysfunction |
|
Definition
can utilize provocation testing in the pre partum population
MET/manual techniques are safe, position accordinly though
Use of a materinity SI-LOC brace
Stabilization ex can be performed
Avoid supine positiong after 1st trimester |
|
|
Term
|
Definition
physically active women have less
physical stress + growing abdomen stresses surrounding tissues |
|
|
Term
|
Definition
avoid traction, ultrasound, electrotherapy, and diathermy
avoid manipulation
find alternative positions for supine tx after 4th month if pt is sympotamtic for venous occlusion (hypotension syndrome)
maternity belt |
|
|
Term
|
Definition
heaaches
blurred vision
severe abdominal pain
severe bleeding
decreased fetal movement |
|
|
Term
| Post partum: pain after pregnancy predictor |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Fatigue
Chills
Night Sweats |
|
|
Term
|
Definition
|
|
Term
|
Definition
recent infection
resting/night pain |
|
|
Term
|
Definition
|
|
Term
|
Definition
| bladder/bowel dysfunction |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Constitutional/Red/Yellow Flags: (9) |
|
Definition
fatigue
malaise
nausea
paresthesias
numbness
weakness
dizziness
lightheadedness
mentation/cognitive deficits |
|
|
Term
| Constitutional/Red/Yellow Flags: (9) |
|
Definition
fatigue
malaise
nausea
paresthesias
numbness
weakness
dizziness
lightheadedness
mentation/cognitive deficits |
|
|
Term
| 3 routes after evaluation of findgins |
|
Definition
treat
treat and refer
refer |
|
|
Term
| Low Back Red Flags: back related tumor (5) |
|
Definition
age over 50
hx of cancer
unexplained weight loss
failure of conservative therapy
combination of any of the above |
|
|
Term
| Low Back Red Flags: back related tumor: if all red flags missing what does it mean |
|
Definition
| absence of all of the above: 100% sensitive for presence of cancer of the spine |
|
|
Term
| Low Back Red Flags: Back-related infection (osteomyeltis) medical hx |
|
Definition
| recent infection (urinary tract or skin infection) |
|
|
Term
| Low Back Red Flags: back-related infection (osteomyelitis) social hx (2) |
|
Definition
intravenous drug user
alcoholics |
|
|
Term
| Low Back Red Flags: Back-related infection (osteomyelitis): co-morbidities (4) |
|
Definition
diabetics
SCI
post-operative
concurrent immunosuppresive disorder |
|
|
Term
| Low Back Red Flags: Back-related infection (osteomyelitis): Rx drug use |
|
Definition
|
|
Term
| Low Back Red Flags: Back-related infection (osteomyelitis): age |
|
Definition
| typically occurs after 3rd decade |
|
|
Term
| Low Back Red Flags: Back-related infection (osteomyelitis): patient reported symptoms (3) |
|
Definition
night pain
stiffness with difficulty wt bearing
may have constitutional signs |
|
|
Term
| Low Back Red Flags: Back-related infection (osteomyelitis): PT special tests/examination findings (3) |
|
Definition
pain and tenderness over the involved SP (L1 and L2 most affected)
Positive SLR
possible hip pain if infection spreads
heel drop/percussion test |
|
|
Term
| Low Back Red Flags: Cauda equina syndrome: common nerve sign |
|
Definition
| unilateral or bilateral sciatica |
|
|
Term
| Low Back Red Flags: Cauda equina syndrome: bowel/bladder changes |
|
Definition
urine retention or incontinence
fecal incontinence |
|
|
Term
| Low Back Red Flags: Cauda equina syndrome: sensory testing |
|
Definition
saddle anesthesia S2-S5
sensory deficits in the feet (L4, L5, S1) |
|
|
Term
| Low Back Red Flags: Cauda equina syndrome: MMT |
|
Definition
global progressive weakness in the LE
ankle DF, toe ext, ankle PF weakness |
|
|
Term
| Low Back Red Flags: Cauda equina syndrome: causes (4) |
|
Definition
trauma (fx, manipulation)
disc herniation
stenosis
neoplasms |
|
|
Term
| Low Back Red Flags: Cauda equina syndrome: d/t trauma is how common |
|
Definition
|
|
Term
| Low Back Red Flags: Cauda equina syndrome: d/t disc herniation is how common |
|
Definition
somewhat common
1-15% of all cases |
|
|
Term
| Low Back Red Flags: Cauda equina syndrome: d/t stenosis could be a result of what other conditions (2) |
|
Definition
|
|
Term
| Low Back Red Flags: Spinal/Compression Fx: (4) |
|
Definition
female
hx of trauma (minor falls or heavy lifts for individuals with osteoporosis or elderly individuals)
prolonged use of corticosteroids
age over 70 years |
|
|
Term
| Low Back Red Flags: Spinal/Compression Fx: sensitivity/specificity |
|
Definition
| 3 of 4 sensitivity 38, specificity 100+LR 218 |
|
|
Term
| Low Back Red Flags: Spinal/Compression Fx: special tests |
|
Definition
| heel drop/percussion test |
|
|
Term
| Low Back Red Flags: Spinal/Compression Fx: typical MOI |
|
Definition
| flexion compression force d/t macro or micro trauma |
|
|
Term
| Low Back Red Flags: Compression Fx: (5) |
|
Definition
age >52
no presence of leg pain
BMI <22
does not exercise regularly
female |
|
|
Term
| Low Back Red Flags: Compression Fx: sensitivity/specificity |
|
Definition
if 4/5 positive
.37 sens, .96 spec +LR 14.9 |
|
|
Term
| Low Back Red Flags: Lumbar disc herniation: 4 special tests |
|
Definition
ipsilateral SLR before 60 degrees
Crossed SLR
1st MTP extensor weakness
ankle PF weakness |
|
|
Term
| Low Back Red Flags: Lumbar disc herniation: ipsilateral SLR before 60 degrees sens/spec |
|
Definition
.80 sensitive
.40 specific |
|
|
Term
| Low Back Red Flags: Lumbar disc herniation: crossed SLR sens/spec |
|
Definition
|
|
Term
| Low Back Red Flags: Lumbar disc herniation: 1st MTP extensor weakness sens/spec |
|
Definition
|
|
Term
| Low Back Red Flags: Lumbar disc herniation: ankle PF weakness sens/spec |
|
Definition
|
|
Term
| Low Back Red Flags: Prostate cancer: features (3) |
|
Definition
1/3 of all men by age 50
carcinoma present in 50-75% by age 75
most common cancer in men |
|
|
Term
| Low Back Red Flags: Prostate cancer: diagnosis/screening through (3) |
|
Definition
PSA levels
DRE - digital rectal exam
tissue biopsy |
|
|
Term
| Low Back Red Flags: Prostate cancer: pathology: clinical s/s" (8) |
|
Definition
urinary (hesitancy, frequency, urgency, dysuria, decreased flow)
testicular pain
sciatica if metasteses to spine
groin pain
erectile/sexual dysfunction
blood in urine
constitutional signs
impotence |
|
|
Term
| Low Back Red Flags: Prostate cancer: typically metastasizes to where (2) |
|
Definition
|
|
Term
| Thoracic Region: Systemic ORgan Referral: liver |
|
Definition
|
|
Term
| Thoracic Region: Systemic ORgan Referral: pancreatitis |
|
Definition
|
|
Term
| Thoracic Region Red flags: Pyelonephritis (UTI): (3) |
|
Definition
recent or co-existing UTI
enlarged prostate
kindey stone or past kidney stone |
|
|
Term
| Thoracic Region Red flags: Pyelonephritis (UTI): s/s for kindey stones or past kidney stone (5) |
|
Definition
positive murphy percussion test
painful urintation
pain may radiate to back and kidney on affected side
tenderness over the bladder
potential constitutional signs |
|
|
Term
| Thoracic Region Red flags: nephrolithiasis (kidney stones): (8) |
|
Definition
sudden, severe back or flank pain
chills and fever
nausea or vomiting
renal colic
symptoms of UTI/blood in urine
reside in hot humid environment
past episodes of kidney stones
positive murphy's percussion test |
|
|
Term
| Thoracic Region Red flags: nephrolithiasis (kidney stones): renal pain/murphy's percussion test how is it done |
|
Definition
pt prone
one hand over their kidney
punch the back of your hand |
|
|
Term
| Thoracic Region Red flags: Aortic aneurysm: hx (5) |
|
Definition
HTN
Marfan's
abnormal aortic valve disease
cardiac pathology
aging athlete involved in heavy lifting |
|
|
Term
| Thoracic Region Red flags: Aortic aneurysm: current patient status (2) |
|
Definition
|
|
Term
| Thoracic Region Red flags: Aortic aneurysm: pain (3) |
|
Definition
severe chest pain and boring mid thoracolumbar pain
pain described sa tearing or ripping
suddent onset of bilateral groin pain |
|
|
Term
| Thoracic Region Red flags: Aortic aneurysm: heart rhythm/auscultation (3) |
|
Definition
aortic diastolic murmur
pulse deficits
bruits on auscultation |
|
|
Term
| Thoracic Region Red flags: Aortic aneurysm: examination findgins (2) |
|
Definition
abdominal heart beat when lying down (most common)
non mechanical response to physical exam |
|
|
Term
| Thoracic Region Red flags: Aortic aneurysm: how to exam |
|
Definition
periumbilical pulsations
palpate slightly left of midline |
|
|
Term
| Thoracic Region Red flags: Aortic aneurysm: normal to non normal findings (3) |
|
Definition
normwal 2.5 to 3 cm
greater than 3cm refer to MD
>5 cm requires intervention |
|
|
Term
| Thoracic Region Red flags: appendicitis: (3) |
|
Definition
epigastric, periumbilical, right lower quadrant pain
associated nausea, vomiting, and low grade fever
pain is constant and may shift in location |
|
|
Term
| Thoracic Region Red flags: appendicitis: signs/palpation (3) |
|
Definition
Rovsing's sign, pain moves from LLQ to RLQ
Point tender over McBurney's point (1.5-2 inches superomedial to ASIS)
Postive Psoas or Obturaror sign |
|
|
Term
| Thoracic Region Red flags: pancreatitis-non acute: incidence |
|
Definition
|
|
Term
| Thoracic Region Red flags: pancreatitis-non acute: (4) |
|
Definition
pain at mip epigastrum or back t10-l2
pain oted after consuming a heavy meal or alcohol
may refer to left scapular area
abdominal distension, nausea, vomiting, fever, mild jaundice, clay colored stool |
|
|
Term
| Thoracic Region Red flags: cholecystitis: (4) |
|
Definition
colicky pain in right upper quadrant with accompanying right scapular pain
symptoms may worsen with ingestion of large particularly if fatty foods
symptoms not increased by activity or decreased by rest
nausea, vomiting, fever, may be present |
|
|
Term
| Thoracic Region Red flags: cholecystitis (acute): occurs when |
|
Definition
| a stone blocks the cystic duct which carries bile from the gall bladder |
|
|
Term
| Thoracic Region Red flags: cholecystitis (acute): signs (6) |
|
Definition
pain in right upper quadrant
tenderness over the gallbladder
positive murphy's sign
hot rib (tenderness at tip of rib 10, 11, and/or 12)
clay colored stools
increased pain on deep breathing |
|
|
Term
| Thoracic Region Red flags: cholecystitis (acute): murphy's sign sens/spec |
|
Definition
|
|
Term
| Thoracic Region Red flags: cholecystitis (acute): murphy's sign performance |
|
Definition
| it is performed by asking the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (the approximate location of the gallbladder). The patient is then instructed to inspire (breathe in). Normally, during inspiration, the abdominal contents are pushed downward as the diaphragm moves down (and lungs expand). If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner's fingers) and winces with a 'catch' in breath, the test is considered positive. In order for the test to be considered positive, the same maneuver must not elicit pain when performed on the left side. |
|
|
Term
| Thoracic Region Red flags: peptic/duodenal ulcers: (8) |
|
Definition
dull gnawing pain or burning sensation in the epigastrum, mid back, or supraclavicular regions
localized tenderness at the right epigastrum
night pain (12 am-3 am)
constipation
bleeding
vomiting
tarry stools
coffee ground emeses |
|
|
Term
| Thoracic Region Red flags: peptic/duodenal ulcers: duodneal vs peptic ulcer pain differentiation |
|
Definition
duodenal relieved with food
peptic pain may increase with food |
|
|
Term
| Thoracic Region Red flags: ruptured spleen: (3) |
|
Definition
trauma/contusion to the left thoracic region
presents as constant pain in left shoulder
tenderness in LUQ |
|
|
Term
| Thoracic Region Red flags: ruptured spleen: constant pain in left shoulder is what sign which indicates what |
|
Definition
Kehr's sign
free blood or air in teh abdominal cavity |
|
|
Term
| Thoracic Region Red flags: ankylosing spondylitis: what is it |
|
Definition
| progresive inflammatory disease |
|
|
Term
| Thoracic Region Red flags: ankylosing spondylitis: etiology |
|
Definition
|
|
Term
| Thoracic Region Red flags: ankylosing spondylitis: population |
|
Definition
|
|
Term
| Thoracic Region Red flags: ankylosing spondylitis: (4) |
|
Definition
insidious onset of LBP
morning stiffness greater than 1 hour (persistting more than 3 months)
loss of lumbar flexion ROM
hx of chron's, ulcerative colitis |
|
|
Term
| Thoracic Region Red flags: ankylosing spondylitis: what to do to ID SIJ pathology |
|
Definition
|
|
Term
| Thoracic Region Red flags: ankylosing spondylitis: if hx indicates age of onset <40 sens/spec |
|
Definition
|
|
Term
| Thoracic Region Red flags: ankylosing spondylitis: sens/spec if hx indicates pain not relieved by supine |
|
Definition
|
|
Term
| Thoracic Region Red flags: ankylosing spondylitis: sens/spec if hx indicates morning back stiffness |
|
Definition
|
|
Term
| Thoracic Region Red flags: ankylosing spondylitis: sens/spec if hx indicates pain duration greater than 3 months |
|
Definition
|
|
Term
| Thoracic Region Red flags: ankylosing spondylitis: sens/spec if hx indicates 4 of 5 red flags as well as symptoms being improved by exercise |
|
Definition
|
|
Term
| Thoracic Region Red flags: pulmonary embolus:(7) |
|
Definition
chest, shoulder, upper abdominal pain
dyspnea
persistent cough
hemoptysis
teachypnea/tachycardia
fever
hx/risk factor for DVTs |
|
|
Term
| Thoracic Region Red flags: pulmonary embolus: Geneve rule sens/spec |
|
Definition
|
|
Term
| Thoracic Region Red flags: pulmonary embolus: Geneve rule for PE variables (9) |
|
Definition
age over 65
previous DVT or PE
surgery or fx within 1 month
active maligant condition
unilateral lower limb pain
hemptysis
HR 75-94 BPM
HR 95 or more BPM
pain on deep palpation of lower limb or unilateral edema |
|
|
Term
| Thoracic Region Red flags: pulmonary embolus: Geneva rule for PE scoring |
|
Definition
0-3 low probability (8%)
4-10 intermediate (28%)
11+ high probablility (74%) |
|
|
Term
| Thoracic Region Red flags: pancoast tumor: nervous symtoms |
|
Definition
lower cords of brachial plexus creating paresthesias into C8-T1
if cervical chain affected results in Horner's syndrome |
|
|
Term
| Thoracic Region Red flags: pancoast tumor: horner's syndrome |
|
Definition
ptosis
recessed eye
unilateral facial sweating
trophic changes |
|
|
Term
| Thoracic Region Red flags:breast cancer: factors (6) |
|
Definition
peak incidence 45-75
hx in 1st degree relative (premenopausal, bilateral, Mother, daughter, sister)
age at start of menses less than 12
age at menopause greater than 55
first child over the ae of 35
lifelong exposure to estrogen |
|
|
Term
| Thoracic Region Red flags:breast cancer: s/s (10) |
|
Definition
nontender, firm, or hard lump
unusual discharge from nipple
nipple retraction ,itching
rash over breast
generalized hardness over breast
enlarged lymph nodes
swelling of arm
bone or back pain
weight loss
most common in upper outer quadrant |
|
|
Term
| Pelvis Hip and Thigh Red flags: colon cancer: (5) |
|
Definition
age over 50
bowel disturbacnes (rectal bleeding, black stools, change in stool caliber)
unexplained weigh tloss
hx of colon cancer in immediate family
pain unchanged by position or movement |
|
|
Term
| Pelvis Hip and Thigh Red flags: pathological fx of femoral neck (5) |
|
Definition
older women (>70) with hip, groin, or thigh pain
hx of fall from standing position
severe, constant pain that is worse with movement
a shortened and externally roated LE
inability to bear weight |
|
|
Term
| Pelvis Hip and Thigh Red flags: osteonecrosis of teh femoral head (avascular necrosis): (5) |
|
Definition
hx of drug/alcohol abuse
hx of long term corticosteoroid use (RA, SLE, asthma)
hx of hip dislocation, fracture
hx of avascular necrosis of the contralateral hip
trauma |
|
|
Term
| Pelvis Hip and Thigh Red flags: osteonecrosis of teh femoral head (avascular necrosis): clinical s/s (5) |
|
Definition
groin and anteromedial thigh pain
pain worse on w/b
gluteus medius limp
limited hip IR, flexion, abduction
tenderness over hip jt |
|
|
Term
| Pelvis Hip and Thigh Red flags: hip fatigue fx: (7) |
|
Definition
female gender
hormonal irregularities
involved in running, jumping, marching
change in training
nutritional deficiencies
LLD
diminished mm strength |
|
|
Term
| Pelvis Hip and Thigh Red flags: pathologic hip fx: clinical dx tests (2) |
|
Definition
auscultation at pubic symphysis
fulcrum test |
|
|
Term
| Pelvis Hip and Thigh Red flags: pathologic hip fx: clinical dx tests: auscultation at pubic symphysis: what is it? sens/spec |
|
Definition
presentation of dullness when tapping over patella
96 sens
86 spec |
|
|
Term
| Pelvis Hip and Thigh Red flags: pathologic hip fx: clinical dx tests: fulcrum test: what is it? |
|
Definition
pt sitting
PT places hand under involved area of hip
Pressure applied downward over knee with pain provacation being positive |
|
|
Term
| Pelvis Hip and Thigh Red flags: Legg-Calve-Perthes disease: population |
|
Definition
children 2-12
boys ages 5 to 8 |
|
|
Term
| Pelvis Hip and Thigh Red flags: Legg-Calve-Perthes disease: s/s |
|
Definition
gron, thigh pain, medial knee pain
antaglic gait
pain complaints aggravated with hip movement, especially hip adduction and IR |
|
|
Term
| Pelvis Hip and Thigh Red flags: SCFE: population |
|
Definition
age 10-16
male:female 2.5:1
overweight adolescents |
|
|
Term
| Pelvis Hip and Thigh Red flags: SCFE: (4) |
|
Definition
recent growth spurt or trauma
groin pain exacerbated with WB
leg held in ER
ROM limitations in IR and abduction |
|
|
Term
| Pelvis Hip and Thigh Red flags: Peripheral Artery Occlusive Disease: hx (4) |
|
Definition
type II diabetes
ischemic heart disease
smoking
sedentary lifestyle |
|
|
Term
| Pelvis Hip and Thigh Red flags: Peripheral Artery Occlusive Disease: (6) |
|
Definition
age over 60
co-occuring intermittent claudication
unilateral cool extremity
decreased pulses
decreased venous filling times
abnormal ankle to arm systolic BP |
|
|
Term
| Pelvis Hip and Thigh Red flags: Peripheral Artery Occlusive Disease: abnormal ankle to arm systolic BP values |
|
Definition
.8-1 mild PAD
.5-.8 moderate PAD
less than .5 severe PAD |
|
|
Term
| Pelvis Hip and Thigh Red flags: DVT: (4) |
|
Definition
Calf pain, edema, tenderness, warmth
Calf pain intesfied with standing or walking and relieved by rest and elevation
recent surgery, malignancy, pregnancy, trauma, or leg immobilization
Well's Rules 2 or > score |
|
|
Term
| Pelvis Hip and Thigh Red flags: DVT: Well's Clinical Decision Rules for DVT |
|
Definition
Active Cancer within last 6 mos
Paralysis, paresis, recent immob of LE
Recent bedridden for 3 days or major surgery in last 4 weeks
calf tender, politeal space or along femoral vein/ant thigh/groin
entire LE swelling
unilateral pitting edema
collateral superficial veins
alternative dx is as likely as DVT (calf strain, cellulutis) |
|
|
Term
| Pelvis Hip and Thigh Red flags: Compartment Syndrome (Acute: Traumatic or Chronic:Exertion): hx |
|
Definition
| of blunt trauma, crush injury, or unaccustomed exercise |
|
|
Term
| Pelvis Hip and Thigh Red flags: Compartment Syndrome (Acute: Traumatic or Chronic:Exertion): 5 p's |
|
Definition
pain
palor
paresthesia
paresis
pulselessness |
|
|
Term
| Pelvis Hip and Thigh Red flags: Compartment Syndrome (Acute: Traumatic or Chronic:Exertion): is used to determine if it is compartment syndrome |
|
Definition
|
|
Term
| Pelvis Hip and Thigh Red flags: Compartment Syndrome (Acute: Traumatic or Chronic:Exertion): symptoms |
|
Definition
severe persistent leg pain that is intensifed with stretch applied to involved mm
swelling exquisite tenderness and palpable tension (hardness) of involved compartment |
|
|
Term
| Pelvis Hip and Thigh Red flags: septic arthritis (infectious, bacterial): hx |
|
Definition
recent infection
surgery
injection
STD
RA
Lyme's disease
indwelling catheter
immunosuppresive disorder |
|
|
Term
| Pelvis Hip and Thigh Red flags: septic arthritis (infectious, bacterial): pt reported symptoms |
|
Definition
| constant aching and or throbbing pain, jt swelling, tenderness, and warmth in the presence of illness |
|
|
Term
| Pelvis Hip and Thigh Red flags: septic arthritis (infectious, bacterial): clinical symptoms |
|
Definition
fever
chills
malaise
single or multiple painful jts
elevated sedimentatino rate
skin lesions
pain on weight bearing, painful with all movement testing |
|
|
Term
| Knee, Leg, Foot, and ankle Red flags: acute gout: peak age |
|
Definition
|
|
Term
| Knee, Leg, Foot, and ankle Red flags: acute gout: dx |
|
Definition
|
|
Term
| Knee, Leg, Foot, and ankle Red flags: acute gout: symptoms |
|
Definition
severe pain
swelling
heat
readness
exquisite local tenderness
tophi
jt pain and swelling
fever and chills
malalise
redness |
|
|
Term
| Knee, Leg, Foot, and ankle Red flags: acute gout: common locations and most common location |
|
Definition
1st MTP (most common 90%)
instep
heel
ankle
knee
wrist |
|
|
Term
| Knee, Leg, Foot, and ankle Red flags: acute gout: precipated by what |
|
Definition
alcohol intake
dehydration
trauma
high intake of foods high in fat content |
|
|
Term
| Knee, Leg, Foot, and ankle Red flags: acute gout: what are tophi |
|
Definition
| lumps under the skin made up of chalk urate crystals which may erupt through the skin |
|
|
Term
| Knee, Leg, Foot, and ankle Red flags: osteosarcoma: 3 common features |
|
Definition
most common type of bone cancer in ages 10-25 and into adulthood
typically occurs in epiphyses where active growth takes place
80-90% in long bones |
|
|
Term
| Knee, Leg, Foot, and ankle Red flags: osteosarcoma: most common locations |
|
Definition
lower end of femur
proximal tibia/fibula
upper humerus |
|
|
Term
| Knee, Leg, Foot, and ankle Red flags: osteosarcoma: s.s |
|
Definition
pain and swelling at site of lesion
loss of motion at affected joint
tender lump
pathologic fx
occasional weight loss
malaise
fatigue |
|
|
Term
| Head, Face, and Neck Red flags: Cervical Central Cord Lesion: (6) |
|
Definition
older age
post trauma
incontinence
gait disturbances d/t hyperreflexive LE
pain referall to all 4 extremities
UE (especially hand) atrophy and paresis |
|
|
Term
| Head, Face, and TMJ Red flags: vertebrobasilar insuffiency (7) |
|
Definition
dizziness
vertigo that lasts for minutes not seconds
visual disturbances
headaches
nausea
loss of consciousness
apprehension with end range neck mvmts |
|
|
Term
| Head, Face, and TMJ Red flags: Subarachnoid Hemorrhage (4) |
|
Definition
headache of sudden onset that is the worst headache of the patient's life
brief LOC
neurologic dysfunction, nausea, vomiting\
meningeal irritaiton signs |
|
|
Term
| Head, Face, and TMJ Red flags: subarachnoid hemorrhage: what are the 5 meningeal irritations signs |
|
Definition
nuchal rigidity
fever
photophobia
nausea
vomiting |
|
|
Term
| Head, Face, and TMJ Red flags: meningitis: 1 sign, 2 tests |
|
Definition
positive slump sign
kernig
brudzinski's |
|
|
Term
| Head, Face, and TMJ Red flags: meningitis: s/s (7) |
|
Definition
headache
fever
GI signs of vomiting and symptoms of nausea
photophobia
confusion
seizures
sleepiness |
|
|
Term
| Elbow, Wrist, and Hand Red flags: ALS: |
|
Definition
weakness and atrophy of hands and forearms (painless atrophy)
may have both UMN and LMN involvement
fasciculation with premotor neuron |
|
|
Term
| Elbow, Wrist, and Hand Red flags: ALS: early signs |
|
Definition
difficulty lifting the front part of foot and toes (foot drop)
weakness in leg, feet, or ankles
hand weakness or clumsiness
slurring of speech or trouble swallowing
mm cramps and twitching in your arms, shoulders and tongue |
|
|
Term
| Components of screen exam (5) |
|
Definition
emphasis on body systems (integ, cardiopulm, MS, neuromuscular)
ID at risk pt's
Atypical s/s (red/yellow flags)
correlation of s/s
review of systems/systems review |
|
|
Term
| 5 step screeing model for diff dx |
|
Definition
past medical hx
risk factor assessment
clinical presentation
associated s/s
review of symptoms |
|
|
Term
|
Definition
cardiovascular
pulmonary
GI
urogenital
pscyhologic
endocrine
nervous system
integumentary |
|
|
Term
| 3 most common co-morbidities in outpatient orthopedica |
|
Definition
|
|
Term
| at risk drinking adult males |
|
Definition
>14 per week
>4 per sitting |
|
|
Term
| at risk drinking adult females |
|
Definition
>7 per week
>3 per sitting |
|
|
Term
atypical signs and symptoms, slide before visceral pain patterns of medical screening lecture
tbd bartlo's lectures |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: knifelike quality stabbing from inside out, boring, deep aching |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: cuttng, gnawing |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: throbbing |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: bone pain |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: unilateral or bilateral |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: local tenderness to palpation |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: achy, cramping pain |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: may be stiff after prolonged rest but pain level decreases |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: usually unilateral |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: pain pattern related to degree of noxious stimulus; usually unrelated to anxiety |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: pain pattern dull to severe |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: pain pattern mild to severe |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: pain pattern may be mild to severe |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: pain pattern may be affected by anxiety level |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: duration is constant, no change, awakens person at night |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: duration may be constant but is more likely intermittent, depnding on the activity or position |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: duration can be modified by rest or change in position |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: gradual progressive, cyclic pattern |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: night pain |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: location: chest/shoulder |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: accompanied by SOB |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: eating alters symptoms |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: sitting up relieves symptoms (decreased venous return) |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: restriction of active/passive/accessory movements observed |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: one or more particular mvmts catch the client and aggravate pain |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: migratory arthralgias: pain/symptoms last for 1 week in one jt then resolve and appear in another |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: cannot alter, provoke, elmiinate, symptoms |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: altered by movement, pain may become worse with mvmt or some myalgia decreases with mvmt |
|
Definition
|
|
Term
| organ involvement if eating or swallowing affects symptoms |
|
Definition
|
|
Term
| organ(s) if peristalsis affects symptoms |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: symptoms reduced or relieved by rest, change in position, stretching, heat, cold |
|
Definition
|
|
Term
| organ if leaning forward may reduce symptoms |
|
Definition
|
|
Term
| organ if leaning to the affected side may reduce symptoms |
|
Definition
|
|
Term
| organ involved if sitting or leaning forward may reduce symptoms |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: associated s/s: usually none although stimulation of trigger ponits may cuas sweating, nausea, blanching |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: fever, chills |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: night sweats |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: unusual vital signs |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: warning signs of cancer |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: GI symptoms (nausea, vomiting, anorexia, unexplained wt loss, diarrhea, constipation) |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: early satiety |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: bilateral symptoms (paresthesias, weakness, edema, nail bed changes, skin rash) |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: proximal weakness |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: dyspnea |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: diaphoresis |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: headache, dizziness, fainting |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: visual disturbances |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: skin lesions, rashes |
|
Definition
|
|
Term
| Systemic vs Musculoskeletal: bowel and bladder symptoms |
|
Definition
|
|
Term
| Constitutinal signs/redflags: (13) |
|
Definition
fatigue
malaise
fever
chills
sweats
nausea
unexplained weight change
paresthesias
numbness
weakness
dizziness
lightheadedness
mentation or cognitive deficits |
|
|
Term
| Red flags: Features of fatigue (2) |
|
Definition
sense of tiredness or weariness marked by a chnage in ability to carry out normal daily activities
duration of 2 or more weeks |
|
|
Term
| Red flags: Features of malaise |
|
Definition
sense of lethargy; impending illness
patient's intuition "something isn't right" |
|
|
Term
| Red flags: Features of Fevers, chills, and sweats |
|
Definition
99.5 F or higher for more than 2 weeks.
A fever of 102 F or hihger warrants a call to the physician
If elderly a temp of 98.9 F or an increase of 1.3 C over baseline |
|
|
Term
| Red flags: Features of nausea |
|
Definition
low level of nausea
duration 1 to 2 weeks or longer |
|
|
Term
| Red flags: Features of Weight loss or gain |
|
Definition
5 to 10% body weight change
unexplained
over a 4 week period |
|
|
Term
| Red flags: Features of paresthesias, numbness, and weakness |
|
Definition
nondermatomal
multiple spinal nerve root levels
multiple peripheral nerve distribution from multiple spinal nerve root levels
more than 1 extremity |
|
|
Term
| Red flags: Features of Dizziness and lightheadedness |
|
Definition
postural hypotension (CV)
positional (VS)
patient spinning versus room spinning (VS)
motion sicknes or sensitivity (VS) |
|
|
Term
|
Definition
factors that increase risk of transition to disability related to pain
pscyhological, emotinal,. social, occupational |
|
|
Term
| what is the Review of systems |
|
Definition
| checklist of common symptoms representative of a broad spectrum of diseses for a particular body system |
|
|
Term
|
Definition
| anatomic and physiologic status of cardiovascular/pulmonary, integumentary, musculoskeletal, and neuromuscular systems |
|
|
Term
| Cardiovascular system items to screen for ((7) |
|
Definition
dyspnea
orthopnea
palpitations
pain/sweats
syncope
peripheral edema
cough |
|
|
Term
| Cardiovascular systems review, what other items should be considered (6) |
|
Definition
hx of heart problems
family hx
chest pain
claudication
fatigue or nausea
lightheadedness |
|
|
Term
| A cardiovascular screen should be performed regardless, however, if the pt presents with these pain complaints the screen must be more thorough |
|
Definition
chest
L/R shoulder girdle/UE
midthoracic region
epigastric region
neck
jaw
tooth |
|
|
Term
| Pulmonary screen items to look out for (8) |
|
Definition
tachypnea
cough
dyspnea
hemoptysis
sputum
stridor
wheezing
clubbing of the nails |
|
|
Term
| A pulmonary system screen should be performed regardless, however if a a patient presents with these pain complaints, history, or presents with a significant risk your exam should be more thorough |
|
Definition
pain in R/L shoulder girdle
pain in thorax to T-L junction
unresolved/atypical TOS with hx of cancer
significant risk of lung cancer, horner's syndrome |
|
|
Term
| Upper GI items to screen for (5) |
|
Definition
dysphagia
nausea
vomiting
heartburn/indigestion
specific food intolerance |
|
|
Term
| Lower GI items to screen for (6) |
|
Definition
constipation
diarrhea
caliber
difficulty iniating defecation
color
incontinence |
|
|
Term
| a GI screen should be performed regardless, however, if a patient presents with these symptoms, your upper GI screen would be more thorough |
|
Definition
abdominal (epigastric) pain
thorax pain
shoulder girdle pain |
|
|
Term
| you perform a lower GI screen and find these s/s, which would lead your screen to be more thorough (3) |
|
Definition
abdominal (umbilical/hypogastric) pain
lumbar pain
pelvic pain
long term use of NSAIDS, corticosteroids, narcotics |
|
|
Term
| Urogential items to screen for, regarding urinatoin (7) |
|
Definition
frequency (nocturia)
urgency
color
dysuria
reduced caliber of urine stream
reduced force of urine stream
incontinence |
|
|
Term
| urogenital system items to screen for regarding reproduction for both males and females (3) |
|
Definition
discharge
imotence
dyspareunia (pain during intercourse) |
|
|
Term
| urogenital system items to screen for regarding reproduction for females (4) |
|
Definition
menstruation
number of pregnancies including complications
number of deliveries including complications
menopause (yes/no) |
|
|
Term
| urogenital system items to screen for regarding reproduction for females: regarding menstruaton (6) |
|
Definition
frequency
length
dysmenorrhea
blood flow
date of last period
was it a normal period? |
|
|
Term
| urogenital system items to screen for regarding reproduction for females regarding menopause |
|
Definition
|
|
Term
| When should a urogenital screen be performed more thoroughly |
|
Definition
hx of serious Urogenital disease or disorder
pain in flank (unilateral thoracolumbar region)
costovertebral angle/thoracolumbar junction pain
lumbar pain
pelvic pain |
|
|
Term
| If pt presents with L/R should pain which systems should be screen (3) |
|
Definition
cardiovascular
pulmonary
gastrointestinal |
|
|
Term
| if pateitn presents with thoracic spine pain which systems should be screened |
|
Definition
cardiovascular/peripheral vascular
pulmonary
gastrointestinal
urogential (T-L junction) |
|
|
Term
| Which systems to screen if lumbar pelvic pain |
|
Definition
gastrointestinal
urogenital
peripheral vascular |
|
|
Term
| Which systems to screen if if R/L knee pain |
|
Definition
|
|
Term
| Which systems to screen if incosistent symptomatic pattern |
|
Definition
psychologic
endocrine
neurologic
rheumatic |
|
|
Term
| Red flags for endocrine system (9) |
|
Definition
arthralgias
myalgias
muscle cramps
neuropathies
cold/heat intolerance
skin or hair changes
gastrointestinal
urogenital
psychologic |
|
|
Term
| s/s of hypothyroidism (14) |
|
Definition
dry scaly skin
brittle hair/nails
cold intolerance
weight gain
constipation
fatigue
arthralgias
myalgias
dyspnea
periorbital edema
slow reflex relaxation
bradycardia
hoarseness
decreased sweating |
|
|
Term
| s/s of Hyperthyroidism (12) |
|
Definition
increased sweating
nervousness
tremor
heat intolerance
weight loss
fatigue
mm weakness (proximal)
mm cramping
palpitations
tachycardia
tachypnea
exophthalmos (protrusion of the eyeballs)
diarrhea |
|
|
Term
| when should a more thorough endocrine system review be performed |
|
Definition
hx of serious endrocrine system disorder
yes answers to general health items
inconsistent symptoms pattern |
|
|
Term
| General Nervous System Screen: Initial Observations (7) |
|
Definition
balance
gait
gross mvmt patterns
tremors
asymmetric facial features
hearing
mentation |
|
|
Term
| General Nervous System Screen: Initial Observations asymmetric facial features include what (4) |
|
Definition
pupils
strabismus (single cross eye)
ptosis
facial contour |
|
|
Term
| General Nervous System Screen: Follow Up questions: (6) |
|
Definition
smell
taste
visual acuity
swallowing
diplopia
speech |
|
|
Term
| General skin observations to screen for |
|
Definition
pallor
cyanosis
jaundice
gray |
|
|
Term
| skin pallor would indicate what |
|
Definition
absence of pigment
blood abnormality |
|
|
Term
| skin cyanosis would indicate what |
|
Definition
|
|
Term
| jaundiced skin would indicate what |
|
Definition
|
|
Term
| gray skin would indicate what |
|
Definition
| high body levels of metal |
|
|
Term
| Skin Lesion characteristics: benign or cancerous: <6 mm |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: uniform color |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: borders distinct/smooth |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: symmetric shape |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: soft to firm consistency |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: no friability |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: seldom ulceration |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: mobile |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: slow rate of change |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: >6mm |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: varied/black color |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: irregular/indistinct borders |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: asymmetric shape |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: firm to hard consistency |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: often friable |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: often ulcerate |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: mobile/nonmobile |
|
Definition
|
|
Term
| Skin Lesion characteristics: benign or cancerous: rate of change is slow or rapid |
|
Definition
|
|
Term
| ABCDE's for Moles and Melanomas: A |
|
Definition
|
|
Term
| ABCDE's for Moles and Melanomas: B |
|
Definition
|
|
Term
| ABCDE's for Moles and Melanomas: C |
|
Definition
|
|
Term
| ABCDE's for Moles and Melanomas: D |
|
Definition
|
|
Term
| ABCDE's for Moles and Melanomas: E |
|
Definition
|
|
Term
| ABCDE's for Moles and Melanomas: sens/spec |
|
Definition
|
|
Term
| 7 point scale for skin cancers: 1 or more major signs present would indicate a biopsy, what are the major signs (3) |
|
Definition
| change in size, shape, or color |
|
|
Term
| 7 point scale for skin cancers: 3 or more minor signs present would indicate a biopsy even in absence of major signs, what are these minor signs? (6) |
|
Definition
inflammation
crusting
bleeding
sensory changes
diamater greater than 7 mm |
|
|
Term
| 7 point scale for skin cancers: sens/spec |
|
Definition
|
|
Term
| Basal cell cancer risk factors (3) |
|
Definition
family hx
immunosuppression
prolonged sun exposure |
|
|
Term
| squamos cell cancer risk factors (4) |
|
Definition
prolonged sun exposure
premaligant skin lesions
radiation therapy
local exposure tar and oil |
|
|
Term
| Melanoma risk factors (5) |
|
Definition
prolonged sun exposure
premaligant skin lesions
family hx
previous hx of melanoma
caucasian (fair skin, blond/redhair, blue eyes) |
|
|
Term
| most common skin cancers in head and neck region |
|
Definition
squamos cell (80%)
basal cell (65%) |
|
|
Term
| Melanoma prognosis and reoccurence |
|
Definition
prognosis depends on depth of lesion
can reoccur more than 5 years after initial surgery |
|
|
Term
|
Definition
five nonorganic signs and seven non-anatomic or behavioral descriptor of symptoms
tests utilized to ID pai nbehavior and abnormal illness behvaior |
|
|
Term
|
Definition
| 3 or more positive signs suggests non-movement dysfunction |
|
|
Term
| Wadells's: 5 nonorganic signs |
|
Definition
tenderness
simulation tests
distraction
regional disturbances
overreaction |
|
|
Term
| Wadells's: 5 nonorganic signs: tenderness refers to what |
|
Definition
superficial palpation painful over a wide area. unable to localize
nonanatomic: deep tenderness felt over a wide area, not localized to one structure |
|
|
Term
| Wadells's: 5 nonorganic signs: simulation tests what are they |
|
Definition
axial loading (light pressure over vertex in standing produces LBP)
acetabular rotation: lumbosacral pain from upper trunk rotation: LBP reported with pelvic and trunk rotation within first 30 degrees |
|
|
Term
| Wadells's: 5 nonorganic signs: distraction refers to what |
|
Definition
| difference in SLR in supine versus femoral testing in sitting. Should be equal |
|
|
Term
| Wadells's: 5 nonorganic signs: regional disturbances refers to what |
|
Definition
weakness-cog-wheeling or giving way of many muscle groups with MMT
sensory disturbances - diminished sensation fitting a stocking rather than a dermatomal pattern |
|
|
Term
| Wadells's: 5 nonorganic signs: Overreaction |
|
Definition
| disproportionate verbalization, facial expression, muscle tension, and remor collapsing or sweating. May exhbiti physical behvaiors of guarding, bracing, rubbing, sighing, clenching teeth, and grimacing |
|
|
Term
| Wadells's non-anatomic or behavioral description of symptoms (7) |
|
Definition
pain at tip of tailbone
whole leg pain in stocking pattern
whole leg numbness or whole leg "going dead"
whole leg giving way
constant pain for years without relief
unable to tolerate any tx
ER admission for LBP without precipitating traumatic events |
|
|
Term
| Major depressive disorder for women and men |
|
Definition
|
|
Term
| major depressive disorder and co-morbodities |
|
Definition
| 20-25% of indiviuals with diabetse, stroke, MI, cancer have MDD |
|
|
Term
| how many with major depressive disorder will commit suicide |
|
Definition
|
|
Term
| Screening for depression: 2 questions to ask, sens/spec |
|
Definition
over the past 2 weeks have you felt down, depressed or hopeless and/or
little interest or pleasure in doing things
96% sens
57% spec |
|
|
Term
| if 3-4 of these (7) present without a reason (bereavement/illness) and symptoms impair social, work, or other function a referall is in order. what are the 7 thigns to look for? |
|
Definition
significant weight change
insomnia
psychomotor agitation/retardation
fatigue
feeling of worthlessness
decreased concentration
recurrent thoughts to suicide |
|
|
Term
| Depression in the geriatric population |
|
Definition
depressed affect often absent
confusion or change in mentation
pain complaints |
|
|
Term
|
Definition
caucasian males
more than 45 years of age
divorced or single
medical hx: major depression, alcoholism, schizophrenia, previous suicide attempt, sense of hopelessness |
|
|
Term
| when to be concerned about suicide risk |
|
Definition
i don't know how much longer I can take this
abrupt improvement in mood |
|
|
Term
| Antidepressant meds side effects: tricyclics (3) |
|
Definition
sedation
anticholinergic effects
postural hypotension |
|
|
Term
| Antidepressant meds side effects: SSRI's |
|
Definition
GI upset
dry mouth
decrease in perspiration
increased HR
constipation
incresae in BP
blurred vision
memory problems
loss of coordination (ataxia)
sensitivity to heat |
|
|
Term
| how long does an SSRI take to be effective therapeutically |
|
Definition
| 4-6 weeks assuming compliance |
|
|
Term
| NSAID GI Complication risk factors: (7) |
|
Definition
older than 60
previous hx
high dose (multiple NSAIDS)
dosage duration greater than 3 moths
concomitant corticosteroid therapy
hx of RA
alcohol or tobacco use |
|
|
Term
| NSAID GI Complication: clinical manfiestations (8) |
|
Definition
clinically silent
abdominal/thoracic spine pain
night pain
indigestion/heartburn
nasuea
pain relief with food ingestion
melina
fatigue |
|
|
Term
|
Definition
| 60-80/100 depends on source |
|
|
Term
|
Definition
SBP 80-120 mmHg
DBP 60-80 mmHg |
|
|
Term
| resting vitals: adult o2 sat |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| resting vitals: child O2 sats |
|
Definition
|
|
Term
|
Definition
| o2 sat around 88% at rest |
|
|
Term
| resting vitals: normal deviation in viatls in this population |
|
Definition
| acute medical issues or surgery |
|
|
Term
| Exercising Vital signs: HR |
|
Definition
| should rise with exercise |
|
|
Term
| Exercising Vital signs: HR after acute injury |
|
Definition
| 10-20 bpm above resting or check maximal stress test results |
|
|
Term
| Exercising Vital signs: chronic pathology HR |
|
Definition
| start with 20-30 BPM above resting and progress from there at each exercise session |
|
|
Term
| Exercising Vital signs: healthy adult HR |
|
Definition
endurance testing
karvonen |
|
|
Term
| Exercising Vital signs: BP changes |
|
Definition
SBP should increase and then level off
DBP should increase slightly or remain the same |
|
|
Term
| Exercising Vital signs: O2 sat |
|
Definition
|
|
Term
|
Definition
perceived exertion
BORG
dyspnea scale
talk test |
|
|
Term
| Phase I of cardiac rehab recovery |
|
Definition
In pt hospital post MI, surgery, acute exacerbation of dx
follow facility protocol
monitor vialts very closely
stress education on lifestyle change and self monitoring of exertion level |
|
|
Term
| Phase II of cardiac reahb recovery |
|
Definition
In home or outpt rehab setting
start ex at 20-30 bpm above resting (10-29 bpm if pt on beta blockers)
Progress pt as tolerated
Increase to 30-40 min of ex including warm up and cool down
educaiton applies lifestyle changes and self monitoring of ex tolerance |
|
|
Term
| Phase III cardiac rehab recoivery |
|
Definition
pt on their own usually
semi-supervised program at phase II facility
PT progresses their program with HR target established at the end of PHase II
Goal is eventually 40-60 min of ex including warm up and cool down
pt monitors their own exertion
pt needs to develop life long ex habits |
|
|
Term
| biggest side effect of HTN and CHF meds |
|
Definition
|
|
Term
|
Definition
|
|
Term
| required medication for patients with medication that they must bring to every session |
|
Definition
|
|
Term
| what should you know about beta blockers |
|
Definition
| HR not an appropriate indicator of exercise tolerance |
|
|
Term
| side effect of Ca+ blockers in regards to ther ex |
|
Definition
|
|
Term
| side effect of ACE inhibitors |
|
Definition
|
|
Term
| side effect of long term corticosteroid use (such as COPD) |
|
Definition
| risk of decreased bone density |
|
|
Term
| Endurance Test examples (4) |
|
Definition
10 meter walk velocity test
TUG
six minute walk test
1 mile walk test |
|
|
Term
| General cardiopulm screen |
|
Definition
eipgastric pain
SOB
fatigue
dizziness
palpitations |
|
|
Term
|
Definition
pain or pressure in sub-sternal area, shoulder, UE, jaw, epigastric region
Pain or pressure with associated malaise, fever, chills, or change in heart sounds
edema and/or rapid weight gain
abnormal vital sign response to exercise
moderate to extreme SOB with minimal exertion |
|
|
Term
|
Definition
|
|
Term
|
Definition
persistent cough (productive or non productive)
sudden onset SOB, or no known etiology of SOB, but has persisted for several days
Thoracic cage pain
SOB with or without thoracic pain, but also has malaise, fever, cough
chest or bac pain that is deep, nagging,a nd wakes the pt up at night (may or may not have cough too) |
|
|
Term
| how to differentiate chest pain |
|
Definition
locaiton of pain (general, local, pinpoint)
changes with movement, coughing, deep breathing, valsalva maneuver
constant/intermittent
response to activity
radiation to other areas |
|
|
Term
| Chest pain differentiated: difference between chest angina and MI |
|
Definition
| MI same as angina but does not subside with rest or nitro |
|
|
Term
| Chest pain differentiated: features of Chest angina |
|
Definition
localized area, but not usually pin point
follows ischemia locations
onset at certain activity level and then subside with rest
beware of unstable angina or stable becoming unstable |
|
|
Term
| Chest pain differentiated: pericrdial origin (pericarditis features) |
|
Definition
usually see increase with deep breathing, coughing, swallowing, movement, and lying down
sitting up and leaning forward cause pain to decrease |
|
|
Term
| Chest pain differentiated: pulmonary HTN features |
|
Definition
pain absent at rest
occurs when exertion and has SOB but not relieved with nitro so not angina |
|
|
Term
| Chest pain differentiated: Chest wall pain features |
|
Definition
pain is intermittent, variable intesnity, local tenderness
occurs after exertion, not during it |
|
|
Term
| Chest pain differentiated: pleuritis or pleural effusion |
|
Definition
pin point or very localized pain
worse with deep breathing
better with sidebending toward affected side |
|
|
Term
| Chest pain differentiated: pneumothorax features |
|
Definition
pin point pain over area of collapse, but may radiate across chest or abdomen
worse with deep breaths and pleaural stretching
beetter with sidebending toward side of collapse |
|
|
Term
| Chest pain differentiated: Lung cancer (6) |
|
Definition
pain is usually deep
nagging or aching pain described
does not change much (worse or better) with motion
SOB with all activity/exertion
Wakes pt up at night
May or may not have cough |
|
|
Term
| Back pain differentiated: 5 features to look at |
|
Definition
constant/intermittent
radiation from other areas
changes with mvmt, valsalva maneuver
neurologic involvement
response to activity |
|
|
Term
| Cardiopulmonary causes of back pain: angina or MI with radiation to back features |
|
Definition
| will not decrease with rest or lying down |
|
|
Term
| Cardiopulmonary causes of back pain: posterior rib fx features |
|
Definition
| worse with positoining over area that is fx |
|
|
Term
| Cardiopulmonary causes of back pain: pericarditis features (2) |
|
Definition
worse with deep breathing, trunk rotation, and side bending
better with forward flexion, sitting, and valsalva |
|
|
Term
| Features to consider when differentiate LE pain (6) |
|
Definition
radiation from spine
constant/intermittent
response to activity and then to rest
possible neuropathies
sudden onset or more chronic
ABI (homan's is not reliable) |
|
|
Term
| how to differentiate circulatory vs neurological problem with ABI |
|
Definition
| decreased ABI indicates circulatory |
|
|
Term
| Cardiopulmonary causes of LE pain: intermittent claudicaiton features |
|
Definition
PT's with PVD
pain comes on with activity/amb at a certain rate, alleviated with rest
pain is described as burning, but location is usually mm belly and not dermatomal |
|
|
Term
| Cardiopulmonary causes of LE pain: PE |
|
Definition
sudden onset or chronic for several days
usually groin, poplitea fossa, or calf
nagging pain, not neurologic description |
|
|
Term
| Features to consider when differentiating shoulder or neck pain (5) |
|
Definition
sudden onset or more chronic
locaiton of pain (general, local, pinpoint)
constant/intermittent
neurologic involvement
response to ROM and activity |
|
|
Term
| Cardiopulm causes of SHoulder pain: angina or MI |
|
Definition
| same presentation when in back |
|
|
Term
| Cardiopulm causes of SHoulder pain: pericarditis |
|
Definition
| may radiate to shoulder but pt will also have chest or back pain |
|
|
Term
| Cardiopulm causes of SHoulder pain: pneumothorax |
|
Definition
| may radiate to ipsilateral shoulder but pt will also have chest pain over area of collapse |
|
|
Term
| 5 signs of activity intolerance |
|
Definition
chest pain
increased cough or temperature
increased dyspnea at rest
altered mental status
inccreasing weakness or fatigue |
|
|
Term
| When the pt should seek medical attention: P |
|
Definition
| patient has anginal symptoms not relieved by nitrates |
|
|
Term
| When the pt should seek medical attention: S (3) |
|
Definition
syncopal episode with irregular pulse
sudden weakness and/or increased fatigue
shoulder or spine pain that increases with coughing or deep breathing |
|
|
Term
| When the pt should seek medical attention: R (2) |
|
Definition
recent weight gain with LE edema and dypsnea
rapid HR with decreasing BP |
|
|
Term
| When the pt should seek medical attention: N (2) |
|
Definition
new onset calf pain (check ABI)
new onset of a feeling of palpitatoins and you palpate irregular pulse rate |
|
|
Term
| When the pt should seek medical attention: I |
|
Definition
| increase in HR or BP above acceptable ranges without return to baseline after rest |
|
|
Term
| When the pt should seek medical attention: F |
|
Definition
| frequent asthma attacks or decreased effectiveness of inhaler |
|
|
Term
| most common diagnostic testing referring to body fluid sand tissues for PT considerations (2) |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| normal hemoglobin for women |
|
Definition
|
|
Term
| normal hemoglobin for men |
|
Definition
|
|
Term
| Hemoglobin therapy precautions |
|
Definition
Hemoglobin less than 8 is a typical cut off point
not an absolute contraindication |
|
|
Term
| normal white blood cell count |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| decreased endurance, activity tolerance, increased fatigue, increased risk of tachycardia |
|
|
Term
|
Definition
risk of infection
use isolation of mask protection as appropriate |
|
|
Term
| what to do with increased/decreased platelet count |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Hyperkalemia value and danger |
|
Definition
|
|
Term
| hypokalemia value and danger |
|
Definition
|
|
Term
| normal Na levels and dangers |
|
Definition
136-143 136-143 mmol/L
excess leads to tachycardia
not enough leads to bradycardia |
|
|
Term
| normal CA levels and dangrs |
|
Definition
4.5-5.3 gm/dL
too much tachycardia
not enough bradycardia |
|
|
Term
| Cl abnormalities can lead to what |
|
Definition
| problems with extracellular fluid balance (edema or dehyardation) |
|
|
Term
|
Definition
|
|
Term
| pH values below 7.35 are... |
|
Definition
|
|
Term
| ph values above 7.45 are... |
|
Definition
|
|
Term
| pH imablane may be caused by (2) |
|
Definition
respiratory system (CO2)
metabolic system (ketoacidosis from fat metabolism) |
|
|
Term
|
Definition
35-45 mm/Hg
36-44 per text |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| causes or respiratory acidosis |
|
Definition
alveolar hypoventilation from head injury (anoxia), drug overdose
anything that causes retention of CO2 |
|
|
Term
| respiratory acidosis symptoms/presentation |
|
Definition
anxiety
headache
dyspnea
confusion
coma |
|
|
Term
| Causes of respiratory alkalosis |
|
Definition
alveolar hyperventilation (panic attack)
anything that causes decrease of CO2 |
|
|
Term
| symptoms presentation of respiratory alkalosis |
|
Definition
| tingling, numbness, syncope |
|
|
Term
| causes of metabolic alcolosis (3) |
|
Definition
diabetic ketoacidosis
lactic or uremic acidosis
prolonged diarrhea |
|
|
Term
| metabolic acidosis symptoms/presentation |
|
Definition
| vomting, dysrrhythmias, lethargy, coma |
|
|
Term
| causes of metabolic alkalosis |
|
Definition
bicarobnate ingestion
too much diuresis causing dehydration
vomiting |
|
|
Term
| symptoms/presentation of metabolic alkalosis |
|
Definition
|
|
Term
| ideal blood glucose range |
|
Definition
|
|
Term
| Hypoglycemia is considered what |
|
Definition
|
|
Term
| Hypoglycemia can e caused by what (5) |
|
Definition
exercise
over exertion
changes in insulin dosing
illness
lack of food |
|
|
Term
|
Definition
headache
weakness
irritability
hunger
decreased level of consciousness |
|
|
Term
|
Definition
|
|
Term
|
Definition
| lack of medication, poor diet control |
|
|
Term
|
Definition
| sweet smlling breath dehydration weak and rapid pulse |
|
|
Term
|
Definition
| measure of long term control of diabetes |
|
|
Term
| HbA1c controlled glucose levels |
|
Definition
|
|
Term
| Kidney function tests: Normal blood urea nitrogen (BUN) |
|
Definition
|
|
Term
| Kidney function tests: increased levels of Blood urea nitrogen d/t what |
|
Definition
| kidney damage d/t renal disease, certain drugs, heart failure, dehydration, internal bleeding |
|
|
Term
| Kidney function tests: decreased levels of blood urea nitrogen d/t what |
|
Definition
| poor nutrition and liver damage |
|
|
Term
| Kidney function tests: creatinine normal range |
|
Definition
|
|
Term
| Kidney function tests: creatinine increased levels d/t what |
|
Definition
| kindey disease, drugs, and mm degeneration |
|
|
Term
| Kidney function tests: decreased levels of creatinine d/t what |
|
Definition
kiney damage
liver disease
pregnancy |
|
|
Term
| Kidney function tests: normal BUN/creatine ratio |
|
Definition
|
|
Term
| Liver function tests: albumin normal |
|
Definition
|
|
Term
| Liver function tests: albumin increased d/t what |
|
Definition
|
|
Term
| Liver function tests: album decreased in what |
|
Definition
proteinuria
inflammation
malnutrition
pregnancy |
|
|
Term
| Liver function tests: bilirubin normal |
|
Definition
|
|
Term
| Liver function tests: bilirubin increased d/t what |
|
Definition
liver disese
jaundice
hemolytic anemia |
|
|
Term
| Liver function tests: s/s to look for with abnormal values |
|
Definition
signs of altered mental status
level of consciousness
edema
ascites
RUQ pain
musculoskeletal pain |
|
|
Term
| Hemostatic/Anticoagulation tests: PT/INR normal values |
|
Definition
| normal values of 2-3 in pt's tx with coumadin/heparin |
|
|
Term
| Hemostatic/Anticoagulation tests: PTT normal time |
|
Definition
|
|
Term
|
Definition
| lipoproteins manufactures from sugars and carbohydrates |
|
|
Term
| Hyperlipidemia clinically dx as (5) |
|
Definition
triglycerides >185 mg/dL
Total cholesterol >240 mg/dL
HDL's <35 mg/dL
LDL's >100 mg/dL
ratio of total CHOL/HDL >4.5 |
|
|
Term
| lipid profiles are unreliable after what |
|
Definition
| major medical event such as surgery or MI |
|
|
Term
|
Definition
cardiac enzymmes
infectious disease
pancreatic disease
hormone function |
|
|
