Npte - Other Systems

Front 1

Phenylketonuria

Back 1

Elevation of serum phenylalanine.
Results in mental retardation
Children are tested at birth
Autosomal recessive trait most common in whites
Tx - dietary restriction of phenylalanine

Front 2

Tay-Sachs Disease

Back 2

Autosomal recessive disease resulting in missing enzyme that leads to accumulation of gangliosides -> child develops symptoms at 6 months, missing developmental milestones - > dies usually by age 5

Front 3

Mitochondrial Disorders

Back 3

Over 100 forms, each with different levels of disability.
Genetic or spontaneous mutations in DNA lead to impaired mitochondria.
s/s - loss of muscle coordination, muscle weakness, visual and hearing problems, learning disabilities, heart, liver, kidney diease, respiratory neuro, GI disorders, dementia.

Front 4

Wilson's disease

Back 4

Rare inherited disorder - autosomal recessive
Defect in body's ability to metabolize copper
Accumulates within brain, liver, cornea, kidney, and other tissues.
Symptoms normally appear by age 6 with a ring around iris.

Front 5

Medical conditions which may cause low bone mass

Back 5

Cushing's syndrome, osteomalacia, hyperthyroidism, hyperparathyrdoism, celiac disease, RA, renal failure, hypogonadism, osteogenesis imperfecta

Front 6

Cushing's Syndrome

Back 6

Too much cortisol
Adrenal dysfunction
s/s - hyperglycemia, growth failure, truncal obesity, purple abdominal striae, moon shaped face, buffalo hump posteriorly at the base of the neck, weakness, acne, hypertension, male gyno. Mental changes include depression, poor concentration, memory loss
Tx - pharmacological intervention, radiation, chemo, surgery

Front 7

Paget's Disease

Back 7

Heightened osteoclast activity. Excessive bone formation lacks true structural integrity.
Large, weak bone
Tx - pharmacology; weight control, exercise, cardiac fitness

Front 8

Metabolic Alkalosis

Back 8

pH >7.45
Commonly occurs after continuous vomiting, ingestion of antacids or other alkaline substances, duiretic therapy..
s/s - nausea, diarrhea, prolonged vomiting, confusion, muscle fasciculations, cramping, convulsions
Tx - manage underlying cause, give pt potassium chloride

Front 9

Metabolic Acidosis

Back 9

pH <7.35
Commonly occurs with renal failure, lactic acidosis, starvation, diabetic or alcoholic ketoacidosis, severe diarrhea, or poisoning.
s/s hyperventilation, vomiting, headache, weakness/malaise, can induce coma/death if untreated
Tx - manage underlying cause; correct electrolyte imbalances, administer sodium bicarbonate

Front 10

Islets of Langerhans

Back 10

Hormone-producing cells of the pancreas

Front 11

Measureing bone mineral density

Back 11

Measured by dual energy xray absorptiometry.
Expressed as t-score (compared to healthy adult) and z-score (compared to age adjusted adult of the same gender)
T score = -1 to -2.5 SD - osteopenia
= -2.5 or lower = osteoporosis
= as above with hx of fractures = Severe osteoporosis

Front 12

Addison's Disease

Back 12

Hypofunction of adrenal cortex -> too little cortisol and aldosterone
s/s include widespread metabolic dysfunction and electrolyte imbalance. Weight loss, hypotension, shock, death

Front 13

Grave's disease

Back 13

Most common cause of hyperthyroidism
- Autoimmune disease where antibodies stimulate thge thyroid gland
- s/s include enlargement of thyroid gland (goiter), heat intolerance, nervousness, weight less, tremor, palpitations
- tx - pharmacology, radiation or surgical removal of thyroid

Front 14

DM type 1

Back 14

Pancreas fails to produce enough insulin.
Normally diagnosed in childhood but can occur at any age
Also known as insulin-dependent or juvenile diabetes
Ketoacidosis more common in type 1 than type 2

Front 15

DM type 2

Back 15

Typical onset is over 40
Body has a resistance to insulin
Obesity is common

Front 16

Normal blood glucose

Back 16

70-130 g/dl before meal
<180 after meal

Front 17

Ketoacidosis

Back 17

More common in DM type 1.
Hyperglycemic reaction
When blood glucose is >180-200, s/s appear including thirst and frequent urination.
Progresses to life-threatening condition (ketoacidosis) with s/s including fruiting breath, dry mouth, dyspnea, nausea/vomiting, confusion, eventual LOC

Front 18

Hypoglycemia

Back 18

When blood glucose <70 mg/dl, pt will c/o hunger, sweating, dizziness, clumsiness, headache that will progress to LOC.
May occur during exercise
Give pt glucose or other carb-rich substance

Front 19

Which structure produces bile?
Stores bile?

Back 19

Produces - liver
Stores - gallbladder

Front 20

Rehab considerations for GI patients

Back 20

Recognize electrolyte imbalances.
Increased risk of muscle cramping.
Orthostatic hypotension

Front 21

Kehr's sign

Back 21

he occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated. Kehr's sign in the left shoulder is considered a classical symptom of a ruptured spleen.[1] May result from diaphragmatic or peridiaphragmatic lesions, renal calculi, splenic injury or ruptured ectopic pregnancy

Front 22

Diverticulitis

Back 22

Pouch like protrusions in the colon
Bloating, cramping, constipation

Front 23

Hepatitis A

Back 23

Transmitted by close personal contact.
Presents with flu-like symptoms. Does not progress to chronic disease or cirrhosis of the liver.

Front 24

Hepatitis B

Back 24

Virus that affects the liver and its function. 10% of cases become chronic.
Transmitted by needles, intercourse, blood/semen exposure, maternal-fetal.
Immunization available

Front 25

Hepatitis C

Back 25

Leads to chronic liver disease and eventual failure (in 50% of cases.
Transmitted by needles, intercourse, blood/semen exposure, maternal-fetal.
No immunization

Front 26

Cholecystitis and Cholelithiasis

Back 26

Gallstones
R upper quadrant pain
Often symptomatic

Front 27

Pharmalogical intervention for GERD / dyspepsia

Back 27

Antacids
H2 Receptor Blockers - bind specifically to histamine receptors
Proton Pump Inhibitors

Front 28

Anticholinergics

Back 28

Given for gastric ulcers
-Decrease release of gastric acid

Front 29

Left upper quadrant pain - etiologies

Back 29

Gastric ulcer
Perforated colon
Pneumonia
Spleen injury/rupture
Aortic aneurysm

Front 30

Right upper quadrant pain - etiologies

Back 30

Hepatomegaly
Duodenal ulcer
Cholecystitis
Pneumonia
Hepatitis
Biliary stones (gallstones)

Front 31

Left lower quadrant pain - etiologies

Back 31

Perforated colon
Ileitis
Sigmoid diverticulitis
Kidney stone
Ureteral stone
Intestinal obstruction

Front 32

Right lower quadrant pain - etiologies

Back 32

Kidney stone
Ureteral stone
Meckel diverticulum
Appendicitis
Cholecystitis
Intestinal obstruction

Front 33

Transmission of visceral pain

Back 33

Transmitted by ANS. Helps differentiate musculoskeletal pain from visceral pain if accompanied by nausea, vomiting, pallor, sweating.

Front 34

Endometriosis

Back 34

Development of endometrial tissue (normally lines uterus) in extrauterine locations.
Moderate to severe lower abdominal pain
Tx - myofascial release, relaxation exercises, TENS;
surgery, total hysterectomy, oral contraceptives

Front 35

Renal failure

Back 35

Typically occurs secondary to DM or hypertension.
s/s include nausea, vomiting, lethargy, weakness, anorexia, GI ulcer, sleep disorders, headache, peripheral neuropathy, anemia, pruritus (itching), osteomalacia, ecchymosis, pulmonary edema, seizures, coma
May require dialysis

Front 36

Rehab considerations for patients with renal failure / dialysis

Back 36

- Modify tx based on fluid and electrolyte status
- Recognize patient's abilities post-dialysis and potential for dehydration and hypotension
- Monitor vital signs closely
- Energy conservation techniques should be incorporated

Front 37

Bladder irritants

Back 37

Carbonated, caffeinated, and alcoholic beverages
Spicy foods
Citric juices
Artificial sweeteners

Front 38

Stress Urinary Incontinence

Back 38

Loss of urine during activities that increase intra-abdominal pressure
Risk factors include pregnancy, hx of vaginal delivery, epesiotomy, prostate/pelvic surgery, aging, DM, recurrent UTI, obesity (increased IAP)
8-12 weeks of physical therapy recommended

50% of nursing home admissions have direct relationship to unresolved urinary incontinence

Front 39

Urge Urinary Incontinence

Back 39

Loss of urine after a sudden intense urge to void.
The most common type of incontinence in elderly.
Triggered by conditioned reflex such as water running or "key-in-the-lock" when coming home.
Behavior modification is primary tx including scheduled voiding

Front 40

Overflow Urinary Incontinence

Back 40

Loss of urine when pressure in bladder exceeds urethra's capacity to stay closed.
Caused by outflow obstruction. These pts also often have difficulty initiating urine stream, with post-void dribble (neat)

Front 41

Functional Urinary Incontinence

Back 41

Can't or wont get to the potty

Front 42

Physical Therapy for Incontinence

Back 42

0/5-2/5 on muscle test:
- biofeedback, e-stim, bladder re-training, therex, pelving floor strengthening includes tapping of pelvic floor muscles, overflow exercises using buttocks, adductors, lower abdominals; Kegel exercises
- 3/5-5/5: above plus weighted vaginal cones, pelvic floor muscle exercise during activitiy

Front 43

Obstetric Musculoskeletal Pathology

Back 43

Coccydynia (becomes hypermobile and painful)
Diastasis Recti
Piriformis Syndrome
Symphysis Pubis Pain (complications or large infant can lead to soft tissue injury around joint)

Front 44

Diastasis Recti

Back 44

Diagnosed by 3 or more fingers separation when patient lifts her head.
Tx - stabilization exercises, postural awareness exercises, body mechanics training

Front 45

Physiological and Postural Changes During Pregnancy

Back 45

- Weight gain between 25-35 pounds; anemia may occur
- Uterus ascents into abdominal cavity becoming an abdominal organ
- Ribs expand to accommodate the uterine ascent; respiratory diaphragm elevates four centimeters
- Increased depth of respiration, tidal volume, and minute ventilation
- Increased oxygen consumption (15-20%), blood volume (45-50%), and cardiac output (30-60%)
- Hypotension in supine position during pregnancy from pressure on inferior vena cava
- Abdominals become overstretched; ligaments become lax secondary to hormonal changes
- Joints may become hypermobile

Front 46

Exercise & Pregnancy

Back 46

50-60% max HR for ~30 min per session
At least 3x per week
Stop exercising when fatigued
NWB preferred
Loose clothing advised
Adequate fluids
No supine after first trimester
Pelvic floor muscle exercises (80-100 contractions per day combining quick, long hold, and functional contractions)

Front 47

Contraindications for Exercise during pregnancy

Back 47

Absolute:
- Hemodynamically significant heart disease
- Restrictive lung disease
- Incompetent cervix/cerclage (risk of miscarriage)
- Multiple gestation at risk for premature labor
- Persistent second or third trimester bleeding
- Placenta previa after 26 weeks of gestation
- Premature labor during the current pregnancy
- Ruptured membranes
- Preeclampsia / pregnancy-induced hypertension

Relative:
- Severe anemia
- Unevaluated maternal cardiac dysrhythmia
- Chronic bronchitis
- Poorly controlled type 1 diabetes
- Extreme morbid obesity
- Extremely underweight (BMI <12)
- History of extremely sedentary lifestyle
- Intrauterine growth restriction in current pregnancy
- Poorly controlled hypertension
- Poorly controlled hyperthyroidism
- Heavy smoker

Front 48

Best position for high-risk pregnancy

Back 48

L side-lying

Front 49

% of pregnant women who experience back pain

Back 49

70%

Front 50

PT for high-risk pregnancy

Back 50

Often on bed rest
Left sidelying is best position
D/c abdominal exercises
Allow minimal exertion only
Avoid valsalva
Provide instruction on proper body mechanics
Educate about c-section rehab
Monitor & report any uterine contraction, bleeding, amniotic fluid loss

Front 51

Anuria

Back 51

Inadequate urine output; less than 100 ml
- Severe dehydration, shock, end-stage renal disease

Front 52

Cystocele

Back 52

Bulging of bladder into vagina

Front 53

Ectopic

Back 53

Implantation of a fetalized ovum outside of the uterus (most commonly fallopian tube)

Front 54

Endometrium

Back 54

Inner lining of uterus that is shed monthly

Front 55

Glomerulus

Back 55

Specialized tuft of capillaries that are needed for the filtration of fluid as blood passes through the arterioles of the kidneys

Front 56

Hematuria

Back 56

Blood in urine
- cancer, faulty catheterization, serious disease

Front 57

Impotence

Back 57

Impairment of ejaculation, orgasm, erection, and/or libido

Front 58

Myometrium

Back 58

Muscular outer layer of uterus

Front 59

Nephrolithiasis

Back 59

Kidney stones

Front 60

Nocturia

Back 60

Frequency at night
- DM, CHF

Front 61

Oliguria

Back 61

Urine output less than 400 ml

Front 62

Polyuria

Back 62

Large volumes of urine

Front 63

Perimetrium

Back 63

The serous peritoneal coat of the uterus

Front 64

Radical mastectomy

Back 64

Surgical procedure in which the entire breast, pectoral muscles, axillary lymph nodes, and some skin are remove secondary to breast cancer

Front 65

Rectocele

Back 65

Bulging of anterior wall of rectum into the vagina secondary to weakneing of pelvic support structures

Front 66

Seminiferous tubules

Back 66

Coiled tubes found in each lobe of testes where spermatogenesis takes place

Front 67

Urea

Back 67

Major nitrogen-containing end product of protein metabolism normally cleared from the blood by the kidney into the urine

Front 68

Urinary frequency

Back 68

Voiding more than 8 times in a 24 hour period.
- Overactive bladder, reduced bladder capacity, painful bladder syndrome, increase urine output caused by uncontrolled DM

Front 69

Urinary urgency

Back 69

The sudden desire to urinate that is stronger than usual and difficult to defer.
- Detrusor overactivity, bladder infection, inflammation or presence of foreign body such as stones or tumors.

Front 70

General signs and symptoms of cancer

Back 70

CAUTION
C - Change in bowel/bladder routine
A - A sore that will not heal
U - Unusual bleeding/discharge
T - Thickening/lump develops
I - Indigestion or difficulty swallowing
O - Obvious change in wart/mole
N - Nagging cough/hoarseness

Front 71

Cancer staging

Back 71

0 - Early malignancy only present in layer of cells in which it began
1 - Limited to tissue of origin with no lymph involvement or metastasis
2 - Spreading to adjacent tissues; lymph nodes may shown signs of micrometastasis
3 - Spread to adjacent tissues showing sign of fixation to deeper structures. High likelihood of metastatic lymph node involvement
4 - Metastasis

Front 72

Exercise guidelines for patients undergoing cancer treatment

Back 72

Side effects of tx include - pain, fatigue, depression, anxiety, altered body image, sleep disturbances, lymphedema, GI distress

- Check physician orders for WB status, especially with bone mets
- Monitor blood values daily, especially platelet and hematocrit counts
- Keep exercise at 40-65% max HR
- RPE should not exceed 12
- Schedule visits when pt has most energy

Front 73

PT for patients undergoing chemo and radiation

Back 73

- Massage and heat contraindicated for 12 months over irradiate areas
- Most heat and e-stim contraindicated over malignant areas
- This may be overlook for palliative care for terminally ill patients
- Cognitive changes are common

Front 74

Oncological pharmacology

Back 74

Alkylating Agents
Antimetabolite Agents
Antibiotic Agents
Plant Alkaloid Agents (Mitotic Inhibitors)
Biologic Response Modifier Agents
Heavy Metal Compounds

Front 75

Adjuvant

Back 75

treatment provided in addition to other cure-focused interventions

Front 76

Benign neoplasm

Back 76

Abnormal cell growth that is usually slow growing and harmless

Front 77

Dysplasia

Back 77

Abnormal development of cells or tissue that is often an early sign of neoplasia

Front 78

Hyperplasia

Back 78

Increase in cell number than may be normal or abnormal

Front 79

Malignant neoplasm

Back 79

Abnormal uncontrolled cell growth that invades and destroys adjacent tissues and may metastasize to other sites and systems in the body

Front 80

Metaplasia

Back 80

Change in a cell from one type to another that may be normal or abnormal

Front 81

Neoadjuvant

Back 81

Chemotherapy or radiation given prior to surgical oncology intervention

Front 82

Neoplasm (tumor)

Back 82

Abnormal new growth of tissue that increases the overall tissue mass. Tumors are benign (non-cancerous) or malignant (cancerous) as well as primary or secondary. Primary tumors form from cells that belong to the area of the tumor. Secondary tumors grow from cells that have metastasized (spread) from another affected area within the body. Tumor classification is defined by cell type, tissue of origin, amount of differentiation, benign versus malignant, and anatomic site.

Front 83

Cancer

Back 83

A group of diseases characterized by uncontrolled cell proliferation with mutation and spreading of the abnormal cells. The etiology is based on the type and location of the cancer. The most common causes include cigarette smoking, diet and nutrition, chemical agents, physical agents, environmental causes, viral causes, and genetics.

Front 84

Affective Disorders

Back 84

Depression, mania, bipolar

Front 85

Neuroses

Back 85

Maladaptive strategies in dealing with stressful or everyday stimuli.
OCD
Anxiety disorder
Phobia disorder

Front 86

Dissociative Disorders

Back 86

Develop when a person unconsciously dissociates (separates) one part of the mind from the rest.
Psychogenic Amnesia - forgets past
Multiple personality

Front 87

Somatization Disorder

Back 87

Complaints of symptoms with no physiological basis

Front 88

Conversion disorder

Back 88

Physical complaints with no underlying cause
Most common - paralysis, deafness, blindness, parasthesia

Front 89

Hypochondriasis

Back 89

Excessive fear of illness
Believes that minor illnesses or medical problems indicate a serious of life-threatening disease

Front 90

Types of schizophrenia

Back 90

Catatonic - rigid posture and/or uncontrolled movements
Paranoid - Delusions of grandeur / persecution. May believe they have special powers
Disorganized - Usually progressive and irreversible with inappropriate emotional responses, mumbled talking

Front 91

Psychopathic Personality

Back 91

Low morality, poor sense of responsibility, no respect for others
Impulsive behavior for immediate gratification; high frustration
Little guilt or remorse for all actions; inability to alter behavior, even with punishment
Expert liar

Front 92

Antisocial behavior

Back 92

Lacks responsibility and emotion stability but typically has some concern for others

Front 93

Narcissistic Behavior

Back 93

Incapable of loving others
Self-absorbed; obsessed with self and power
Unrealistic perception of self-importance

Front 94

Borderline Behavior

Back 94

Instability in all aspects of life
Uses projection, denial, defensiveness, unpredictable mood or behavior
Intense or uncontrolled anger; chronic feelings of emptiness

Front 95

Interacting with escalating patient

Back 95

- Be empathetic when setting boundaries
- Low, calm tone of voice
- Do not respond defensively to patient comments
- Offer choices, options, or small concessions
- Allow patient to look away
- Be respectful and acknowledge the patient's complaints or frustrations
- Wait for patient to pause rather than raising your voice
- Leave area if necessary
- Avoid physical contact
- Do not turn your back
- Do not allow patient to block your exit route
- Maintain more space than usual
- Stand at an angle facing the patient so that it is easier to sidestep if needed
- Stay at the same eye level as the patient (both standing or sitting etc)
- Keep hands out of your pockets

Front 96

Child - overweight or obese?

Back 96

BMI - 85th - 94th percentile = OVERWEIGHT
95 or higher - OBESE

Front 97

Female Athlete Triad Syndrome

Back 97

Disordered eating
Amenorrhea
Osteoporosis