PathophysFinal

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kdarnell
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PathophysFinal
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2011-04-29 15:23:31
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PathophysFinal
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  1. What is the leading cause of death in the US?
    Coronary heart disease
  2. condition in which fatty material collects along the walls of the arteries. this material thickens, hardens (plaques) and may eventually block arteries---??
    atherosclerosis
  3. LDL is considered______(good/bad) cholesterol.

    transports cholesterol _____(to/from) cells
    BAD

    transports to cells
  4. HDL is considered ______(good/bad) cholesterol.

    transports _____(to/from) cells
    GOOD

    transports from cells
  5. Are the following risks non-modifiable or modifiable?
    1. age (above 40)
    2. genetics
    3.gender
    4.obesity
    5. high fat diets
    6. smoking
    7. sedentary lifestyle
    8.diabetes
    9. hypertension
    10. heavy alcohol consumption
    1-3 non

    4-10 modifiable
  6. when do cardiac conditions affect men? (early/late)

    when do cardiac conditions affect women? (early/late)
    affect men early

    affect women late
  7. course of CAD:
    C-reactive proteins
    elevated C-reactive proteins
  8. course of CAD:
    WBCs/lipids
    WBCs and lipids accumulate at site
  9. course of CAD:
    muscle cells
    smooth muscle cells multiply
  10. course of CAD:
    thrombus
    thrombus formation creates obstruction
  11. HDL and LDL levels for norms
    HDL: greater than 60

    LDL: less than 100
  12. chest pain is also called...?
    myocardial infarction
  13. MI is caused by?
    decreased O2 to myocardium as a result of obstructed arteries
  14. 3 types of CAD
    • stable
    • unstable
    • variant
  15. what is the stable subtype of CAD?
    chest pains with physical exertion or emotional stress

    most common

    predictable
  16. what is the unstable type of CAD?
    unexpected

    usually occurs at rest

    can be severe and prolonged

    may procede a MI
  17. what is the variant type of CAD?
    spontaneous and nearly always occurs at rest

    due to vasospasm at rest
  18. signs and symptoms of CAD
    chest tightening

    can be felt anywhere between belly button and jaw

    sweating, loss of breath, palor, nausea
  19. treatment of CAD
    usually subside with rest

    coronary vasodilators

    if it persists seek medical attention
  20. what is the primary cause of a MI?
    atherosclerosis
  21. what are the 3 primary mechanisms of MI?
    1. thrombus obstructs pathway

    2. vasospasm leads to total obstruction

    3. embolus flows thru coronary a. before it lodges in smaller branch
  22. signs and symptoms of MI
    angina greater than 20 mins

    sweating, loss of breath, palor, fear and nausea
  23. what is a silent heart attack?
    no symptoms
  24. treatment of MI
    CPR

    rest, O2 therapy, beta blockers, ace inhibitors, surgeries

    if blood can be restored within 20-30 mins prevents damage
  25. co-morbidities of MI
    • stroke
    • CHF
    • pulmonary embolism
  26. what is a cardiac dysrhythmia?
    deviation from hearts normal beat cycle

    caused by interference in hearts conduction system
  27. types of cardiac dysrhythmias?
    • SA node
    • AV node
    • atrial conduction abnormalities
    • ventricular conduction abnormalities
  28. signs and symptoms of cardiac dysrhytmias
    • angina
    • fainting
    • SOB
    • sweating
    • similar to all other cardiac conditions
  29. purposely destroying a dysfunctional area of the heart causing the abnormal rhythm
    cardiac ablation
  30. whats another name for asystole?
    cardiac arrest
  31. why does asystole occur?
    loss of consciousness due to lack of O2 to brain
  32. causes of pneumonia
    • infection
    • aspiration
    • organisms such as bacteria, fungi, virus
  33. course of pneumonia
    depends on type and how soon treatment is started

    can be very fatal in very old or very young
  34. type of pneumonia:
    inflammation of alveolar wall and leakage of cells, fibrin, and fluid into alveoli causing consolidation
    lobar pneumonia
  35. type of pneumonia:
    inflammation and purulent exudate in alveoli often arising from prior pooled secretions or irritations
    bronchopneumonia
  36. type of pneumonia:
    interstitial inflammation around alveoli
    interstitial pneumonia
  37. clinical features of lobar pneumonia
    high fever

    cough with rusty sputum

    rales progressing to absence of breath
  38. clinical features of bronchopneumonia
    mild fever

    cough with yellow-green sputum

    dyspnea
  39. clinical features of interstitial pneumonia
    variable fever and headache

    aching muscles

    nonproductive hacking cough
  40. clinical features of Legionnaires
    cough may be severe

    diarrhea

    nausea,vomitting, GI issues

    headaches, muscle aches, chest pain, SOB
  41. clinical features of pneumocystis
    difficulty breathing

    nonproductive cough
  42. co-morbidities of pneumonia
    • lung abcess
    • ARDS
    • sepsis
    • respiratory failure
    • pleural effusion
  43. causes of tuberculosis
    • oral droplets
    • coughing, forced respiratory movements
    • bacteria
  44. who are most easily infected with tuberculosis?
    children
  45. course of tuberculosis
    anorexia, night sweats, fatigue, weight loss set in

    cough gets more productive and severe

    sputum more purulent
  46. if tuberculosis is untreated what happens?
    disease destroys large portion of lungs and other organs
  47. what are the 2 stages of tuberculosis?
    primary and secondary
  48. primary tuberculosis subtype
    bacteria into lungs and causes inflammation

    tubercle forms

    caseation necrosis occurs in middle of tubercle

    6-8 weeks infection complete although disease not active
  49. secondary tuberculosis subtype
    considered active infection stage after years of infection

    bacteria multiply spread into lungs and other areas
  50. tests for TB
    skin test, blood test, sputum test
  51. does primary tuberculosis display symptoms?
    no!
  52. secondary tuberculosis clinical features
    gradual onset

    systemic signs appear first
  53. signs and symptoms of tuberculosis
    weight loss, anorexia, fatigue

    night sweats

    prolonged cough that becomes more severe

    purulent sputum with blood
  54. co-morbidities of tuberculosis
    • collapsed lung
    • organ failure
    • joint damage
    • meningitis
    • death
  55. cause of CF
    genetic

    mutated 7th chromosome

    autosomal recessive
  56. what ethnicity does CF affect most?
    whites
  57. what is the course of CF?
    lifespan is increasing

    chronic cough increases over time

    respiratory failure is common cause of death
  58. CF and lungs
    mucus obstructs bronchioles which causes air trapping
  59. CF and prancreas
    exocrine ducts become blocked
  60. other organs involved with CF
    small intestine

    bile ducts of liver

    salivary and sweat glands

    reproductive organs
  61. tests for CF
    sweat analysis

    stool analysis
  62. clinical features of CF
    • salty skin
    • cant gain weight
    • abdominal distention
    • inability to meet growth landmarks
    • fatigure--endurance issues
  63. co-morbidities of CF
    • diabetes
    • osteoporosis
    • chronic infection
    • cirrhosis
    • collapsed lung
  64. cause of asthma
    actual cause is unknown

    children with sedentary lifestyle
  65. course of asthma
    depends on severity

    cause reversible bronchial obstruction

    chronic asthma causes irreversible damage in lungs when severe and frequent
  66. extrinsic asthma
    childhood onset

    acute

    type 1 hypersensitivity
  67. instrinsic asthma
    adult onset

    triggered by infections, aspirin, exercise, cold
  68. what happens in both types of asthma
    bronchioles and bronchi constrict

    increased mucus and edema

    obstruction, hypoxia
  69. clinical features of asthma
    • cough, dyspnea
    • wheezing
    • hypoxia
    • thick mucus
  70. co-morbidities of asthma
    • GERD
    • obesity
    • depression
    • sinusitis
  71. causes of COPD
    chronic exposure to lung irritants
  72. what is the most common cause of COPD
    smoking!
  73. course of COPD
    irreversible and progressive damage to lungs

    results in hypoxia
  74. alveolar walls and septae are destroyed leading to permanently inflated alveolar air spaces, smoking is a cause

    describes...?
    emphysema
  75. fibrosis and thickening of bronchi wall occurs from constant irritation from smoking or exposure to industrial pollution. oxygen levels are low and during coughing episodes cyanosis occurs.

    describes...?
    chronic bronchitis
  76. irreversible abnormal dilation of the bronchi caused by recurrent inflammation and infection in the airways, indilated areas, large amounts of fluid constantly collect and become infected
    bronchiectasis
  77. clinical features of emphysema
    • gradual onset
    • dyspnea on exertion then with rest
    • barrel chest
    • anorexia and fatigue
    • clubbed fingers
  78. clinical features of bronchiectasis
    • chronic cough with purulent sputum
    • rales
    • dyspnea
    • hemoptysis
    • weight loss
  79. clinical features of chronic bronchitis
    • SOB
    • productive cough
    • cough more severe in morning
    • systemic edema
  80. OT treatment of respiratory conditions
    • ADL's
    • patient education
    • energy conservation techniques
    • breathing strategies
  81. PT treatment of respiratory conditions
    • breathing exercises
    • strengthening and endurance exercises
    • postural drainage
  82. in general: diabetes is caused from what?
    deficiency of insulin from beta cells of islets of langerhans in pancreas
  83. what does insulin do?
    converts sugar, starch and other foods into energy
  84. cause of type 1 diabetes
    immune system destroys beta cells which leads to no insulin production and a build up of sugar in the blood stream
  85. cause of type 2 diabetes
    beta cells become resistant to insulin and pancreas is unable to produce enough to overcome this resistance
  86. cause of gestational diabetes
    placenta builds up an enzyme that is resistant to insulin
  87. acute complications of diabetes
    • hypoglycemia (excess of insulin)
    • diabetic ketoacidosis (low insulin levels, high blood sugar)
    • hyperosmolar hyperglycemic nonketotic coma (insulin deficit)
  88. chronic complications of diabetes
    • microangiopathy (rupture of small vessels and capillaries)
    • macroangiopathy (obstruction of large arteries
  89. 2 subtypes of diabetes:
    initial and progressive
  90. initial stage of diabetes
    • decreased glucose
    • hyperglycemia
    • glucosuria
    • polyuria
    • polydipsia
    • polyphagia
  91. progressive stage of diabetes
    • (more in type 1)
    • excess of ketones from lack of glucose
    • ketonuria
    • dehydration
    • dehydration can lead to diabetic coma
  92. Type 1 diabetes:

    other names and risk factors
    • IDDM, juvenile diabetes
    • genetic
    • environmental (viruses)
    • low vitamin d
    • more common in whites
  93. Type 2 diabetes:

    other names and risk factors
    • NIDDM, mature onset
    • weight, inactivity
    • genetic
    • increased age
    • high LDL/triglycerids
    • low HDL
    • being black, mexican, indian
  94. gestational diabetes risk factors
    • over age of 25
    • if you've had type 2 or prediabetes
    • being overweight before pregnancy
  95. diabetes insipidus
    • inability to regulate fluid
    • inefficiency of production/regulation of ADH
    • polyuria and polydipsia
  96. what are the 3 p's of diabetes?
    polyuria

    polydipsia

    polyphagia
  97. clinical features of diabetes
    • weight loss
    • fatigue
    • nausea
    • glucosuria
    • possible neuropathy
  98. levels for diabetes
    70-100 mg/dL normal

    100-126 mg/dL prediabetes

    anything over 126 mg/DL = diabetes
  99. co-mobidities of type 1 and 2 diabetes
    • cancer
    • wound healing
    • cardiovascular issues
    • neuropathy
  100. co-morbidities of gestational diabetes
    • hypoglycemia
    • jaundice
    • type 2 diabetes
    • preeclampsia
  101. treatment for diabetes
    • healthy diet
    • monitor blood sugar
    • meds
    • physical activity
  102. OT treatment for diabetes
    • ADLs
    • patient education
    • adaptive equipment
  103. PT treatment for diabetes
    • exercise program
    • pt education
    • wound care
    • muscle strengthening and mobility
  104. what causes burns?
    • direct contact with heat
    • chemicals
    • radiation
    • electricity
  105. who is most commonly burned?
    white men
  106. course of burns
    depends on severity, cause of burn, areas impacted
  107. what is the rule of 9's?
    • head and each arm 9%
    • each leg 18%
    • ant/post surface of trunk each 18%
    • groin 1%
  108. superficial partial thickness burns
    • formerly 1st degree
    • damage to epidermis and upper dermis
    • red dry skin painful to touch
    • heal well without scar
    • (mild sunburn)
  109. deep partial thickness burns
    • formerly 2nd degree
    • damage to epidermis and part of dermis
    • area becomes red, blistered, and painful, skin appears waxy
    • burn heals by regenerating from edges
  110. full thickness burns
    • formerly 3rd and 4th degree
    • destroys all skin layers
    • initially may be painless due to nerve destruction
    • skin can be black white yellow brown
    • these require grafts
  111. mechanism of injury of burns
    • scald
    • flame
    • direct contact
    • electrical
    • chemical
    • non-accident
  112. healing phase of scars:

    phase 1
    • (less than 1 week)
    • body removes dead/dying skin
    • body fights infection
    • body sends skin repairer cells
  113. healing phase of scars:

    phase 2
    • (few weeks)
    • body makes collagen fibers to form scar tissue
    • body creates new blood vessels in burned area
  114. healing phase of scars:

    phase 3
    • (months to years)
    • scar tissue matures
  115. PT/OT intervention for burns
    • exercises for joint mobility
    • gaining function thru ADLs
  116. co-morbidities
    • inability to sweat
    • change in skin strength, color, sensation
    • need for skin rehydration
    • shock
    • pain
    • respiratory problems
    • infection
    • metabolic needs
  117. what is osteoarthritis?
    wear and tear

    DJD resulting in pain, stiffness, loss of function
  118. does OA affect other organs?
    NO!
  119. what is the primary form of OA?
    obesity and aging
  120. what is the secondary form of OA?
    injury or abuse
  121. what is the genetic component of OA?
    articular cartilage has acclerate breakdown
  122. course of OA
    • progressive
    • cartilage becomes stiff and loses elasticity
    • loss of cartilage means joint loses ability to be shock absorber
  123. pathophys of OA
    • excessive mechanical stress cause articular cartilage breakdown
    • joint becomes rough and worn
    • tissue damage releases enzymes which accelerate disintegration of cartilage
  124. what happens when OA get more progressed/
    cysts and bone spurs develop and can break off into synovial cavity

    joint becomes more narrow
  125. diagnosing OA
    x-ray, MRI, blood tests
  126. clinical features of OA
    • decreased ROM
    • aberrant movement
    • muscle atrophy
    • crepitus
  127. clinical features of OA if TMJ involved
    mastication as well as opening/closing problematic
  128. clinical features of OA if hands involved
    heberden's node-bony enlargement of DIPs

    swelling
  129. subtypes of OA
    inflammatory

    erosive

    primary

    secondary
  130. inflammatory OA
    • seen in middle aged women
    • affects PIPs and DIPs
    • treated with NSAIDs
  131. erosive OA
    • erosion of cartilage
    • seen in hands
    • pain, tenderness, swelling
  132. primary OA
    • idiopathic
    • seen in older adults
    • caused by wear and tear
  133. secondary OA
    • DJD of synovial joints
    • seen in younger population
  134. co-morbidities of OA
    • upper limb sprain
    • synovial and tendon disorders
    • obesity
    • ischemic heart disease
  135. general treatment for OA
    • no specific treatment to hault degeneration
    • reduce joint pain while maximizing function

    rest, diet, minimal stress
  136. OT treatment of OA
    • assistive devices
    • alternate ways to perform ADLs
  137. PT treatment of OA
    • increase ROM
    • strengthen muscles
    • maintenance of joints
  138. cause of total joint replacement
    unknown
  139. common reasons for hip replacement
    • arthritis-most common
    • osteonecrosis
    • fracture
  140. common reason for knee replacement
    • OA-most common
    • RA
    • post-traumatic arthritis
  141. what is RA
    • autoimmune, body attacks joints because it thinks they are foreign
    • affects joints equally
    • pain on both sides of body
    • joints become stiff and warm
  142. pre-op for TJR
    • pain
    • pay attention to contralateral side
    • has advanced arthrosis
  143. post op for TJR
    • pain
    • mechanical compression and cryotherapy for pain
    • CPM machine to move joint to prevent stiffness
  144. PT and post op
    training for ADLs, gait, transfers, joint mobility
  145. what is the most important aspect before moving the patient?
    weight bearing status!
  146. recovery from surgery
    • continue PT/OT
    • scar formation
    • recovery usually in 12 weeks
  147. PT for TJR
    • gait
    • strengthening
    • joint mobility
    • ROM
    • assistive devices
  148. OT for TJR
    • ADL's/IADL's
    • mobility
    • adaptive devices
  149. types of TJR
    • metal and plastic (most common)
    • ceramic
    • metal on metal
    • cemented vs non cemented
  150. posterior approach to hip replacment
    • goes thru hip rotators
    • most common
    • moore or southern
  151. lateral approach to hip replacement
    goes thru glute med and glute min
  152. anterolateral approach to hip replacement
    goes in btwn glute med and TFL
  153. anterior approach to hip replacement
    goes in btwn sartorius and TFL
  154. unicompartimental knee replacement
    partial knee replacement

    repair medial, lateral or patellar compartment
  155. minimally invasive knee replacement
    spare quads and have smaller incisions
  156. hip precautions following replacement
    do not flex past 90d

    no hip adduction across midline

    no hip ER/IR
  157. knee precautions following replacement
    WB status

    do not cross legs
  158. precautions to providing treatment if patient is experiencing:
    • nausea
    • vomiting
    • confusion
    • light headedness
  159. absolute contra-indications for TKA/THR
    • severe vascular disease
    • sepsis
    • infection
    • osteomyelitis
  160. relative contraindications for TKA/THR
    • muscular atrophy or neurological disorders
    • below 60
    • pregnancy
    • obesity
  161. what are some functional limitations resulting from TJR
    • gait deviations
    • decreased strength
    • limited ROM
  162. co-morbidities of TJR
    • thrombophlebitis
    • bone fracture
    • infection
    • disloaction or loosening of joint
  163. causes of FAS
    mother drinking during pregnancy
  164. effects of FAS
    depend on extent of alcohol consumption

    not normal brain functioning

    growth,mental or physical deficits

    CNS most impacted
  165. pathophys of FAS
    mother drinks and it goes into bloodstream crossing placenta

    babies cannot metabolize alcohol like adults
  166. tests for FAS
    no test to determine

    after birth look at abnormal facial features, growth, CNS, motor skills
  167. clinical features of FAS
    • elongated midface
    • thin upper lip
    • flattened maxilla
    • microcephaly
    • smooth philtrum
    • small palpebral fissure
  168. birth defects of FAS:

    structural
    head circumference at or below 10th percentile

    deformed brain structures
  169. birth defects of FAS:

    neurological
    poor hand/eye coordination/ nystagmus
  170. birthday defects of FAS:

    functional
    • cognitive
    • executive functioning
    • memory
    • fine motor deficits
    • attention problems
    • hyperactivity
    • limited social skills
    • decreased intelligence
  171. additional issues associated with FAS
    • poor coordination
    • decreased muscle tone
  172. subtypes of FAS
    • partial FAS
    • alcohol related birth defects
    • alcohol related neurodevelopmental disorders
    • fetal alcohol effect
  173. co-morbidities of FAS
    • heart defects
    • ADHD
    • lung and kidney defects
  174. treatment for FAS
    • medsb
    • behavior and education therapy

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