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71 Cards in this Set
- Front
- Back
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What is Pathology? |
The study of disease, how it is caused, and how it affects body tissues and organs. |
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What is health? |
The absence of disease. Includes spiritual, mental, and physical aspects. |
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What are the 3 aspects of illness? |
1. Acute: comes on suddenly, and is worse in the beginning
2. Chronic: accumulation of acute illness; long duration with long medical care needed
3. Psychological aspects: pre-illness health can affect this aspect; person's acceptance of disease or illness |
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ICF and the 2 major parts |
International Classification of Functioning, Disability, and Health
Part 1: Functioning and disability (includes body functions and structures, activities and participation)
Part 2: Contextual factors (environmental and personal factors) |
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What does health promotion include? |
Self responsibility, nutritional awareness, stress reduction, and physical fitness. |
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What does disease prevention include? |
Immunities, chemoprevention (reversing or inhibiting cancer), preventative medicines, secondary (promoting early disease detection) and tertiary medicine (limit progression of disease) |
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Systemic affects of pathology: |
-Acute inflammation (lasting about 1 week) -Chronic inflammation (usually in persisting episode; ex: arthritis) -Systemic factors influencing healing (diet and exercise) -Consequences of immunodeficiency (immune system not doing it's job; ex: AIDS) -Systemic affects of neoplasm (lung cancer; chemotherapy may affect heart tissue performance) |
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Adverse drug reactions: |
Unwanted and potentially harmful effects of medicine or prescribed drugs.
-Incidence -Etiologic and risk factors (multiple drugs at one time) -Clinical manifestations (How does the drug reaction affect the body?) |
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What are some common drugs that cause adverse reactions? |
-Corticosteroids -Aspirin -Tranquilizers -Antacids -Insulin overdose -Sedatives |
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Purpura: |
A low level of bleeding in tissue. Commonly seen as a result of thrombocytopenia. -NSAIDs -Radiation -Blood thinners |
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Nonsteroidal anti-inflammatory drugs: |
NSAIDs: heterogeneous group of drugs that reduce inflammation, provide pain relief, and reduce fever |
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Corticosteroids: |
Naturally occurring hormones produced by the adrenal cortex and gonadal tissue. |
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3 types of radiation injuries: |
1. Dry desquamation (dry, cracked skin) 2. Radiation dermatitis (blisters) 3. Radiation recall (like sunburn) |
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Adverse effects of chemotherapy: |
-Alopecia (hairloss) -Gastrointestinal toxicity (change of balance in body) -Myelosupression (no adequate nutrition to cells) -Fatigue -Cardiotoxicity -Renal toxicity -Neuropathies |
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Specific disorders affecting multiple systems: |
-Rheumatoid arthritis (RA) -Tuberculosis (TB) -Multiple organ dysfunction syndrome -Systemic lupus |
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Factors that affect fluid and electrolyte balance in aging: |
-Acute illness -Immobility -Medications -Change in mental status -Constipation |
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What is the normal pH range of the body? |
7.35-7.45 |
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At what pH is cell function severely impaired? |
Below 7.2 or above 7.55 |
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What are 3 systems that maintain normal pH levels? |
1. Blood-buffer system 2. Kidneys 3. Lungs |
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Why are acid-based imbalances high in hospital settings? |
People are sick already and iv fluids can also cause this. |
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Mechanisms of cell tissue injury: |
-Ischemia (lack of blood supply) -Infections agents (bacteria and virus) -Immune reactions (allergies) -Genetic factors (chromosomal abnormalities such as Down's Syndrome) -Nutritional factors -Physical factors (lack of exercise) -Chemical factors (chemotherapy) |
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Risk factors of vitamin C deficiency: |
-Inadequate food intake (anorexia or bed ridden individuals) -Malabsorption syndromes (gluten intolerance) -Moderate to severe physical injury or emotional stress -Pregnancy and lactation -Tobacco products -Obesity -Alcoholism -RA -Kidney dialysis -Diabetes mellitis -Drugs or medications |
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Myocardial infarction: |
Reduced coronary artery blood flow. Irreversible cell injury occurs. Intracellular enzymes are released from the dead heart tissue. |
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Structure of collagen: |
Collagen fiber -> Fibrils -> Polypeptide chains that wrap around one another in a triple helix |
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Factors influencing healing process: |
-Physiologic variables (age and vascular health) -General health of individuals -Presence of co-morbidities (anything health wise that inhibits healing) -Tobacco, caffeine, alcohol -Nutrition -Local or systemic infection -Type of tissue (bone takes longer than skin) -Medical treatment |
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Phases of healing: |
-Hemostasis (lack of blood flow that initiates the coagulation) and Degeneration (start of inflammatory response)
-Inflammation (happens once the blood clot forms)
-Proliferation (regeneration) and Migration (remodeling and maturation)
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Specific tissue or organ repair: |
-Lung (consider pulmonary function when treating pts) -Digestive tract (quickly heals) -Peripheral nerves (slow process of healing) -Skeletal muscle: ->muscle injury -> muscle regeneration -> muscle stiffness -> motor control and muscle inhibition |
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Stages of fx healing: |
1. Hematoma (blood clotting) formation 2. Granulation, tissue, and fibrocartilage formation 3. Soft callus replaced with body callus 4. Remodeling phase with complete restoration of medullary canal |
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Define inflammation: |
-The body's response to injury -Promotes healing -Allows tissue to return to homeostasis
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Cardinal signs of inflammation: |
1. Heat 2. Redness 3. Swelling 4. Pain 5. Loss of function (Most concerning for PT) |
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Inflammation process: |
(What the body does on it's own without medical intervention.)
-Acts to isolate the injured area -Acts to resolve the problem
Responsible for: 1. removal of injurious agent 2. removal of cellular debris 3. initiation of the healing process
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The two types of inflammation: |
1. Acute: -sudden onset -short duration (few hours to several days) -when head subsides, considered subacute -may reoccur -contraindication for some PT: exercise, heat modalities
2. Chronic: (ex: arthritis) -lasts for months or years -acute may progress to chronis -a low grade irritant may produce a chronic inflammation with no acute phase -more likely to produce scar tissue (interferes with function) -PT important: decrease scar production, maintain ROM |
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Causes of inflammatory response: |
-skin abrasions -burns: sunburn, chemical -cuts -trauma from direct blows -infective organisms: bacteria, virus, fungi, protozoa -chemicals: including medicine -foreign bodies |
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Inflammatory Response:
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1. Histamine - released by damaged platelets, initiates edema 2. Bradykinin - similar to histamine, but acts slower, initiates pain 3. Polymorphonucleocytes (PMNs) (neutrophils) - WBC, mobile phagocytic, rid of cell debris in area of inflammation 4. Eosinophils - WBC, kill bacteria chemically 5. Monocytes (early macrophages) that develop into -> Macrophages- main scavenger cells of immune system, long living, present in chronic inflammation 6. Platelets (thrombocytes) - clotters, form connective tissue needed for healing |
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PT for inflammation: |
**For closed injuries:
1. If hot, cool it 2. Generally use ice in acute stage but if remains warm to touch, cool it 3. May use interferential therapy 4. RICE: rest, ice, compression, elevation 5. Rest - NWB in legs, brace, sling, immobilize 6. Ice - decrease pain, decrease inflammation, decrease swelling 7. Compression - controls edema 8. Elevation - controls edema 9. Progress to ES, exercise, ultrasound, massage |
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PT implications to tissue healing: |
- To allow restoration of structure and function whenever possible whether the damage to tissue results from disease, injury, illness, or surgery
-PT should enhance the healing process and should NOT compromise the healing process |
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Cells involved in healing: |
-PMNs: among the first cells to arrive at the injury site to start the cleanup of injured cells
-Myofibroblasts: hold wound together for epithelial cells to gather and cover affected area
-Angioblasts: precursors of blood vessels, form granulation tissue
-Fibroblasts: sticky mesh across wound, holds entire would together |
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The two types of healing: |
**Regeneration of tissue: reversible cell injury -cells replaced by cells of same type, cell mitosis occurs, minimal scar tissue
**Repair: original tissue replaced by scar -repair with fibrous connective tissue, tissue has undergone necrosis and is replaced by tissue that is not the same, loss of function, scar tissue not as strong as original |
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Complications of healing other than delayed healing: |
*Keloid (more common in African Americans)
1. Raised area of scar beyond borders of original wound 2. Results form excessive amount of granulation tissue 3. Too much collagen production 4. Surgical removal results in further keloid formation in about 50% |
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Complications of scarring: |
*Hypertyohic: Thick scars, unsightly, remain within boundary of original wound
*Adhesions: Cause contractures, connects structures together that aren't normally linked (ex: tendon binds to muscle)
*Scar tissue in organs: ex: lungs and liver, interferes with function of organ, stenosis can occur, may occur after surgery and can be life threatening (ex: intestine), shortening of tissue (after burn) |
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Bone Healing: |
*Requirements: 1. Good alignment: may require external or internal fixation 2. Minimal motion 3. Absence of infection 4. About 6-12 weeks for LE 5. About 4-8 weeks for UE |
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External fixation: |
Fixator on outside of body that holds bone in place. Eventually will be removed. |
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Internal fixation: |
Fixator that generally goes into shaft of bone with screws and can have plates also |
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Complications of bone healing: |
-Delayed union -Non-union -Malunion (poor alignment) -Fine Line 1. Too much movement can cause delyed or non-union 2. Too much weight bearing too soon can cause malunion 3. Weight bearing at appropriate amount at appropriate time can enhance bone healing because it stimulates osteoblastic activity |
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Grading ligament injuries: |
**Depends on amount of damage and instability
-Grade I: partial tear: mild or first degree: local tenderness and swelling with no instability
-Grade II: full tear: moderate or second degree: some joint instability
-Grade III: tear that involves bone avulsion: severe or third degree: ligament is completely ruptured: surgical repair needed |
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Classification of Musculoskeletal disorders: |
-Congenital - born with disorder (ex: scoliosis) -Infectious - microorganism (ex: osteomyelitis) -Inflammatory - related to inflammation process (ex: tendonitis) -Metabolic - chemical change in body (ex: gout) -Traumatic - acute (ex: sprain) -Neoplastic - cancer (ex: ostersarcoma) |
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Types of fractures: |
**Classify as open (comes through skin) or closed (does not come through skin)
-Transverse: horizontal to shaft -Spiral: similar to oblique, but has twist -Oblique: happens at an angle -Comminuted: multiple small fractures -Segmental: whole segment (could pull fx section out) -Butterfly: piece of bone broken off -Green stick: not a full fx; ex: bending new tree branch, bends and splinters but no breaks |
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Special types of fractures: |
*Pathological: fx due to pathology; ex: osteoporosis due to weakened bones or cancer due to radiation
*Stress: small fractures due to stress on bone over time; ex: metatarsal fx in runners due to repetition of movement and on females due to malnutrition |
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Presentation of someone with a fracture: |
-Point tenderness -Loss of motion due to pain -May see edema or localized bleeding -Postural changes |
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Pathogenesis of a fracture healing: |
Cell injury -> necrosis -> inflammation -> repair
1-3 days - hematoma, ecchymosis (bruising) due to blood coming from marrow of broken bone
3-7 days - macrophages present - clean out and signal for osteoblasts to start working
1-2 weeks - callus formation
>2 weeks - ossification and remodeling |
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Treatment of fracture: |
*Reduce ASAP (realign) *Immobilize without inhibiting function (ex: splint or boot) |
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Healing times for different ages: |
Children: 4-6 weeks Adolescents: 6-8 weeks Adults: 10-18 weeks
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Fracture complications: |
-Non-union -Damage to adjacent tissues -Infection -Sequelae of bedrest (decreased endurance and muscle capacity, blood clots, DVT) |
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Osteoarthritis: |
**Most common joint disease, hits by age 50
-Slow, progressive degeneration of articular cartilage in weight bearing joints
Primary OA - unknown cause
Secondary OA- caused by trauma, previous injury to a joint, infection
Joints most commonly affected: cervical and lumbar spine, CMC joint, MTP joints |
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Risk factors for OA: |
-Age: men in 40s + and women in 50s+ -Immobility: because of muscle atrophy -Biomechanics: repetitive use; high impact sports -Lack of joint support -Others: genetics, nutrition, weight control
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Pathogenesis for OA: |
-Chondrocyte necrosis; cell death at end of bones where articular cartilage is -Fissuring of articular cartilage and into the bone -No articular cartilage present (eburnation); osteophytes, and narrowing of joint space *DJD
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Signs and Symptoms of OA: |
-Pain: doesn't usually start until there is loss of articular cartilage -Stiffness: and loss of ROM, shape of joints change -Loss of mobility -Crepitus (popping) -Adjacent soft tissue changes |
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Gout: |
-Metabolic disorder caused by elevated serum uric acid levels and depositing of urate crystals in joints, soft tissues, and kidneys
-Incidence/prevalence: high genetic disposition, heavy alcohol consumption, obesity, shellfish, meat, asparagus, spinach, high blood pressure, kidneys can't get rid of excess uric acid so it goes into bloodstream instead.
-common sites: great toe, unilateral foot, ankle, knee, wrist, elbow, fingers |
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Patient presentation: |
-Focal pain -often occurs at night -hypersensitivity
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Osteoporosis: |
**Thinning of bone; based on osteoblast and osteoclast activity
-Metabolic bone disease -Build bone mass until age 30 -Osteoblasts slow after age 30 -Typically seen in menopausal women
*Primary osteoporosis: from the natural aging process and from calcium and vitamin D deficiency *Secondary osteoporosis: due to another disease process such as siliac's disease (gluten intolerance) |
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Risk Factors for Osteoporosis: |
-Race: white, Asian, Latino are most commonly affected -Body habitus: low BMI, boney people, fluctuation of weight -Older age: -Females -Family hx -Nutrition -Lack of activity |
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Osteoporosis related Fx: |
-Men: 1 in 4 men affected -Women: 1 in 2 affected -Common sites: vertebral bodies, hips, ribs, radius, femur, -Diagnosis: Dexa scan; bone density measurer; 3 sites: wrist, lumbar spine, hips |
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Treatment and prevention of Osteoporosis: |
-Medications: calcium citrate
-Preventative measures: exercise, body mechanics training, minimizing risk for fall |
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Osteogenesis Imperfecta: |
-Congenital disorder of collagen synthesis found in children -Body doesn't make enough type 1 collagen -Presentation: hereditary, affects lower extremities more, hearing loss, scoliosis, cardiovascular issues, blue tint to eyes, developmental delay
**Children can be born with fx from coming through birth canal; if epiphyseal plates are affected, can shorten bones; Very easy to fx during adolescence; most will die of cardiovascular or skull issues |
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Musculoskeletal Neoplasms: |
**Tumors**
-Benign: grow but do not metastasize, non cancerous
-Malignant: rapidly growing, metastasize, cancerous
-Metastasis: lymph nodes, liver, lungs, bone, brain are most common sites
-Oncogenes: allow the cancer cell develop into harmful cancer cell |
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Types of Neoplasms:
*oma=tumor *sarcoma=malignancy |
*oma=tumor *sarcoma=malignancy
-Chondrosarcoma: cancer of cartilage -Osteocarcoma: cancer of bone -Synovial sarcoma: very rare; cancer of synovium -Rhabdomyosarcoma: tumor in long muscles -Liposarcoma: tumor in adipose tissue |
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Bone tumors: |
-Cancer cells stimulate osteoclastic activity within the bone which increases bone absorption -Cancer sells can stimulate osteoblastic activity and create *reactive bone*: not normal bone, bad bone, normally in a place where you shouldn't have bone such as joints -Tumor bone/neoplastic bone - osteoids, young bones that aren't calcified -Osteolysis: bone resorption -Osteosclerosis: bone deposit where cancer is present |
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Osteoblastoma: |
**Reactive, but benign bone -> can change shape of bone (See ppt 3 for picture)
-Common in: sacrum, spine, and flat bones, diaphysis of long bones -Can metastasize |
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Osteosarcoma: |
-extremely malignant tumor with lots of lesions and sclerosis - reactive bone formation -2nd most common bone tumor -appear mostly in bone during rapid growth (epiphyseal plates of adolescents)
**Metastasize 20-25% of the time; most often to lungs |
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Multiple Myeloma: |
-Most commonly found in skull, spine, and pelvis - high concentration found in bone marrow -spontaneous fx -present with deep bone pain -very fatal *1-3 years to live*
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Role of the PTA in cancer care: |
-maximize function to optimize quality of life -immobility -endurance -assistive devices/orthoses -gait training -pain management -motor re-learning |
