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186 Cards in this Set
- Front
- Back
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ALT- are _____ that increase when you eat ______
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liver enzymes
fast food |
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Sarcoidosis =
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- rare inflammation common in lungs ex) black lung disease. But it can effect any organ in the body
- seems kinda vague? |
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ESR in your blood =
Bronchectasis = ACE in blood = |
indicates inflammation of something
air pockets in lungs elevated blood pressure |
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highest incidence of fractures are with...
3 most common bones broken in this population- What are some common bones broken in an over 65 years old population? how many hip fractures per year? Hip fracture = |
males 15-24
clavical tibia lower humerous upper femur/ humerous vertebrae pelvis 200,000 femur fracture |
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incomplete fracutres are more common in ...
3 common types--> |
flexible bones of children
greenstick torus bowing |
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define pathologic fractures:
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break at site of pre-existing abnormality but a a force that would not normally fx the bone.
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whats the difference between fatigue fracture and insufficiency frature
(both are types of stress fractures) |
fatigue: abnormal stress to normal bone
insufficiency: normal stress to abnormal bone |
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Transchondral fracture:
most prevalent in... |
seperation of part of articular cartilage that covers the end of a bone in a joint.
adolescents |
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what happens when the blood vessels in the periostenum, cortex and marrow are disrupted?
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a hematoma forms in the medulary canal.
nacrotic bone tissue stimulates inflammatory response osteoblasts build osteoclasts clean callus remodel |
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ORIF =
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open reduction, internal fixation
(surgical allignment) |
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purpose of traction=
3 famous kinds |
to accomplish or maintain reduction- immobilization
1. bucks LE (good before surgery when patient cant put legs up and mves around a lot) 2. dunlop for humerous 3. bone (skeletal) |
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what are some benefits for external fixation?
give a name of a device |
- can take care of infections at the same time
- can weight bear and wiggle toes so less atrophy hoffmans devices |
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leg lenthengin procedure should be done during ___ phase
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callus phase, dont allow bone mineralization right away
fyi- somtimes electric fields can stimulate nerve growth factors |
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Complications of Leg lenthening
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- non union
- psuedarthrosis a fluid filled false joint) - delayed union (8-9 mnonths) - malunion |
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what do you know about tibial pseudoarthrosis?
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they dont heal well, especially with motor cycle injuries
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what movements can pop your hip out?
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flexion
Internal rotation ADDuction |
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Disolcation and subluxation are common in people under..
name two congenital types- |
20 years, and generally associated with stress fractures.
hip talipes equinovarus |
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whats the difference between dislocation and subluxation
what joints are most commonly effected? dislocated hips usually assume what position? |
dislocation- bone surfaces entirly loose contact
sublux- partial loss of contact shoulder elbow wrist finger hip knee shortened, IROT |
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whats the difference between strain and sprain?
how are they classified what 3 things increase the risk of these |
strain - tendon prob
sprain- ligament prob 1-3rd degree (least to most) gluticosteriods RA SLE |
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common sites of strains
commone sites of sprains sprains are associated with an ______ fracture |
patellar, biceps quad, achillies
wirst, elbow, ankle, knee avulsion (chunk of bone is ripped out with the ligament) |
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Discribe healing for sprains and strains
what can PT do? |
4-5 days collagen formation
5-10th day formation along stress lines months/year- scar remodeling gentle ROM and transverse friction massage in 5-10th days Early movement is critical! (helps facilitate fiber formation) |
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bursitis
inflammation can spread along... what does PT generally begin |
usually in middle ages due to trauma (yes over use counts as trauma)
fascial planes post acute stage |
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muscle strains are usually due to-
how do the tissues react? late complications- |
trauma, local muscle damage- suddan force, suddan stretch, wounds
inflammation ct repair muscle regeneration (from satilight cells, 6 wks) 1. myositis ossifications- thought to be calcification of reactive scar tissue 2. myoglobinuria (rhabdomyloysis) !!! |
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describe 3 patterns of Bone Dedstruction
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1. geoprahpic pattern- well defined margins and lytic areas
2. moth eaten pattern- not easily seperated from normal bone 3. permeative pattern- abnormal lytic boe mergers imperceptibly with surrounding normal bone |
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bone tumor =
what is extremly important in preserving life wrt bone tumors- when are these most common |
osteosarcoma
early Dx in kids with growing pains |
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Source of osteosarcoma-
common? SX- RX- |
osteoblasts
the most commom malignant bone forming tumor, especially in kids (more males). fyi- people post radiation treatments (older) - pain and swelling in a leg or arm - along metaphysis 50% at knee worse at night and during exeercise - surgery -pre op and post op chemotherapy |
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the most common benign tumor of bone =
most common malignant tumor- describe the most common malignent tumor |
osteochondroma
chondrosarcoma - usually older men cancer infiltrates trabiculi, especially near metyphysis of long bone. - erodes cortex |
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Signs and symtpoms of chondrosarcoma-
RX- |
local pain
swelling <-- not explainable night pain amputation radiation doesnt really work poor prognosis |
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Most common collagenic tumor =
Who is at risk? |
Fibrosarcoma (malignant)
30-50 years females secondary complication : radiation pagets disease osteomylitis metstasis to the lung is common |
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SX of fibrosarcomas (type of collagenic tumors)
RX- |
insidious onset often delays diagnosis
radiation and amputation |
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Name 2 types of Myelogenic tumors:
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giant cell tumor
myeloma |
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Giant Cell Tumor
1. origin = 2. who's at risk 3. speed of growth |
1. osteoclast origin
2. 20-40 years, females 3. slow but relentless growth within contour of the bone. May eventually spread to articular cartilage |
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Giant Cell Tumor
- SX -RX -malignant? |
pain
local swelling limitation of movement extensivce bone resbsorption cryosurgery with tumor resection or grafts, amputation - no but very aggresive capacity to rapidly destroy bone **recurrance is common |
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cryosurgery =
What is a myeloma? whos ar risk for it? |
use of liquid nitrogen to freeze tumor cells.
neoplastic proliferation of plasma cells females 40 years asians |
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treatmend for giant cell tumors
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liquid nitrogen
recontruction with metal rods bone graft cement |
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Prognosis of Myeloma
treatment- |
poor even with chemotherapy, 3-5 years survival in some cases.
pallative narcotics special beds spinal cord compression NOT: radiation or chemo |
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what accounts for over 40% of primary malignant bone tumors?
Name associated issues because of this type of tumor- some advice for people with myeloma |
myelomas (bone marrow)
- spreads to entire bone marrow and eventually produces death. hypercalcemia anemia infections renal function impaired drink H20 alot wash hands extra iron pills limit Ca+ limits |
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List noninflamatory and inflammatory joint disorders
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NON: DJD primary and secondary
Inflamed: RA ankylosing spondylosis Gout |
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DJD- difference between primary and secondary
DJD is characterizes by: |
primary- wear and tear
secondary- truamatic -erosion of articular cartiledge - sclerosis (hardening) of bone underneath - formation of osteophytes |
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Whats the most common noninflammatory joint disease that effects 60 million USA?
who's more at risk? Is it genetic?? |
ideiopathatic OA
MEN, until age 55 may be inhereted as autosomal recessive trait |
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newer research of OA implicates what?
Clinical manfestations of OA- can they eat anything helpful? |
elevated levels of cytokineses in destruction of cartiledge
- pain and stiffness WB - stiffness eases after 30 min of activitgy - nocturnal pain isnt relieved by rest - parathesis - referred pain from spinal OA maybe yogurt with lots of probiotics |
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FYI- alzheimers disease may be associated with inflammation- just like OA and MANY other diseases
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yucky inflammation
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PT Treatement of OA
meds? |
- ROM to prevent joint capsule contracture
- assitive device - weight loss if obese antiinflamatory neutracuticals probiotics hyaluronic acid injections |
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Bouchard's Nodes:
Caused by: Indicate: Comparable too: |
hard bony growths or gelatinous cysts on the PIP
formation of calcific spurs of the articular joint cartiledge OA Heberdens nodes, OA induced growths on the DIPS, less common though. |
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If the hands are VERY involved, you can rule out what disease?
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Bouchards Nodes (sign of OA)
(bouchards nodes are weird, becuase you dont weight ear on your hands)- they are NOT hot or warm |
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As a group, imflammatory joint disease is often called:
characterized by: infectious? |
arthritis
inflammatory changes to synovial membrane or articular cartiledge infectious: trauma non infect: most common |
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List the most common types of "arthritis" aka inflammatory joint disease
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RA-1 auto immune
ALS- autoimmune GOUT fyi- see an ulnar drift and warm skin with arthritis at hand |
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_______ = systemic autoimmune disorder causing chronic inflammation of CT, especially in joint
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RA
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Whats effected first in Rhuematoid Arthritis?
causes: Incidence: |
antibpodies attackj synovial membrane first(chronic inflammation)
1-2% adults ladies 3:1 men increases with age pain, deformity(due to eroded tendons and ligaments) and loss of fxn. |
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two types of antibodies that attack in RA
RA symtpomd and pregnancy- What does RA look like? |
called rhuematoid factors- two classes of imunoglobulins Igg and Igm
that form immune complexzes with tarhet self-antigens on tissues. - lessens in preg, worsens post partum. boggy thick. squishy, pitted edema kinda hard. |
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Most RA cases begin insidiously with ___% acute onset
How long does it take to devlope? Discribe arthritic joints what is secondary to RA that makes joints even less stable? whta causes exacerbations? |
15%
weeks or months, stiff lasts an hour after waking up and is worse in the AM. (opposite to osteoparthritis) - hairless, thin and shiny flexion contractures, distal subluzations atrophy almost alywas immune system stimulated |
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RA complications
Where are the RA nodues usualy found? |
- excewssive imflamatory exudate forms cysts that can rupture, releasing into tissues and causing inflammation.
- extensor areas - may involve cardiac valve, pericardial pleura, spleen |
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what are common RA positions of the hand?
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ulnar drift
plantar dislocation |
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RA treatment
emerging therapies |
PT
anticancer drugs healthy healthy diet steriods surgery -TNF biological angent |
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TNF=
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tumor necrosis factor- some therapies have been trying to inhibit this protien
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raynauds usualy begins around the ages...
whats the difference between primary and secondary raynauds? |
15-40
primary- color changes with typical symptoms of pain and numbness secondary- with other conditions like scleroderma, carpal tunnel syndrome, RA, lupus |
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How old do you have to be to have juvinile RA
what is the acute systemic form of the disease? |
less than 16years
fever, ra, liver and GI disesase |
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What two periods of childhood are associated with Juv on set of RA?
usually 50% affects more than one joint. What is it called when 4 or more joints are affected? |
1-3 years of age
8-12 years of age polyarticular girls (1-4) knees, ankles, elbows boys (8+) hips and legs females have a worse prognosis than males! |
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ankylosing spondylitis-
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chronic inflammatory disease resulting in the fusion of cartilagiunous joints
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How does the fusing happen in ankylosing spondylitis?
gender incidence? |
fibroblasts secret collagen scar tissue that becomes calcified and ossified- fusion
equal but more severe in men, especially native americans.- might require a envirnmental trigger if it is genetic |
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Clinical Manifestations of Ankylosing Spondylosis-
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Early: LBP, stiffness better with activity
mild: lumbar lordosis flattens and thoracokyphosis increases late: fixed posture, chest pain, painful sitting |
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ALS treatment-
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NSAIDS
analgesics PT surgery/ radiaton for pain relief |
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Gout=
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inflammatory response to uric acid production and excretion resulting in hyperuriceia and in other body fluids, including synovial fluids
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Whats the most common form of inflammatory joint disease in men older than 40?
does avioding certain food help? |
GOUT
yes: sweatbreads, liver, brains, beer, fat lots of meat |
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Gout Pathology-
whats the most common aggravating factor? what should you always remind them of?? |
closly linked to purine metabolism and renal failure. (patients over produce purines and cant excrete them)
trauma drink waaaaaaaaater! |
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Most common site of gout-
If you have gout, what are some things you should eat? |
helix of ear
fyi- gout does have some intercrticial periods between attacks. tofu dark berries nuts |
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secondary muscle dysfunction arises from
give some examples of seconday muscle dys- |
causes unrelated to muscle itself
- contractures - tension -RLS, mypotonia |
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Fibromyalgia is characterized by:
sometimes co-exists with... |
abscence of infalamtion
sleep distrubances fatigue **9 trigger point pain - RA - SLE - other myofascial pain |
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two vocab words that
describe the symptoms of RLS the most distinctive or unsual concept of rls- |
paraesthesias (abnormal sensations)
dysesthesias (unpleasent abnormal sensations) relaxing and lying down activates the symptoms |
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what are some interesting similarites amoung patients with RLS?
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- more calcium in blood
- hypothyrodism - positive for cmv virus - more women - most had severe symptoms |
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myotonia=
caused by- treated by- |
delayed relaxation of skeletal mucsle after voluntary contraction
prolonged depolarization of the muscle membrane NOT terminated by neurmuscular blocking agents drugs that increase muscle excitability |
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what is the best thing about periodic paralysis?
what is periodic paralysis? |
doesnt effect repiratory muscles
muscle is temporarily unresponsive to stimuli with resting membrane potential decrease to -45 |
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two metabolic muscle diseases-
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1. endocrine disorders
2. diseases of energy metabolism |
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endocrine disorders=
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problem with thyriod hormone- that reglates mucsle protien synthesis and electrolyte balance
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Name 2 diseases of energy metabolism-
Define the two |
1. McArdles Disease = inborn abnormal accumulation of glucose in the skeletal muscle due to myophosphorylase deficiency
2. Acid Maltase Deficiency (AMD) = uncommon glucose storage disease, in skeletal muscle, organs, CNS |
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what disease has glucose storing in lysosomal vacules?
Leading to.. |
AMD
congestive heart failure, hypotonia, weak bulky muscles, macroglossea, cardiomegaly |
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Symptoms of McArdles Disease=
what makes symptoms dissappear Onset usualy in... How do they get this?? prognosis- |
muscle pain, muscle cramping following exercise, fatigability.
rest childhood- although diagnosis may be made later becuase they appear normal but tire easily as they age. Then the symptoms start showing. Missing enzyme- autosomal recessive disease not fatal and doesnt affect any other body systems |
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what can a PT do for McArdles Disease?
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- So far, no exercises have been recomended
- low dose creatine good - oral sucrose (but then you may gain weight) |
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inflamatory Muscle disease= name 3
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- myostitis due to viral, bacerterial or parasytic infection.
- polymyositis - dermatomyostis |
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___ and ____ are characterized by inflammation of CT and muscle fibers causing necrosis and destruction of the fibers.
signs and symptoms |
polymyostitis and dermatomystisis
poly is worse and more common SS: - mailase, pain, fever, muscle swelling, tenderness, listliss, lethargy SYSTEMIC PROXIMAL MUSCLE WEAKNESS |
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Nerve Damage direction=
Primary Muscle Damage Direction = |
distal --> proximal
Proximal --> distal |
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Signs that a patient may have dermatomyostis
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skin rash
eyelid purple edema on face chest and extensor surfaces!! |
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Is alchol absorbed directly through the stomach?
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YES insnt that lovely
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Toxic Myopathy=
symptom: Pathology: |
effect of primary alchohol abuse.
- acute muscle weakness, pain and swelling after a binge. - chronic progressive weakness - seen in 20% withdrawl patients necrosis of fibers due to direct toxic effect and nutritional deficiency/ increased serum CK |
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chronic focal myopathy is due to:
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repeated intramuscular injections
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extremly rare benign muscle tumors:
Highly Malignant Striated Muscle Tumors: ----> elaborate --> treatment |
rhabdomyoma
Rhabdomyosarcoma - head neck and GIurinary tract - the spindle cell is considered to be one of the most malignant tumors of the extremites treatment- surgery and chemo but if it has spread, chemo doesnt do much |
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Prognosis of muscle tumors-
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grow fast, tend to be fatal
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Treatment for a patient in Shock-
also give them IV fluid to expand EC volume EXCEPT- |
- with cardio shock, dont lie down
- call 911 - stabalize spine, treat infection, adjust CO and with epi for breathing - neutralize the antigen - minimize loss of core temp in cardiogenic shock when diruisis is indicated |
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why do people sweat when they are in shock?
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muscurinic receptors are activated since sympathetic systme is trying to keep BP up.
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General name for cancerous tumor of smooth mucsle:
of adipose of endothelium of fibroblast |
leiomyosarcoma
liposarcoma angiosarcoma dermatofibrosarcoma |
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When is growth of bone at a maximum?
Weight bearing allows for- when does bone growth end? |
2.5 years of age
spinal curves, femoral and tibial torsion with antigravity and weight bearing 18-20 |
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Genu Varum peaks at what age?
genu valgum? |
2.5 years (bow legged)
5-6 years (knock knee) |
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what does " the greater ant feeds the pigeons" mean?
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femoral retroversion verus femoral anteversion
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Name and breifly discribe the top 3 osteochondrosis
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osteochondrosis- avascular necrosis of the bone
1. scheuremanns disease= vertenral body, could cllapse 2. legg-calve perthes= femur head 3. osgood-schlkatter- tibial tuburcle |
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list some congenetal musculoskeletal alterations-
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- syndactly (web fingers)
- hip dysplasia - foot deformity - metatarsis addictus - equino varus (clubed) |
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Name and briefly discribe 3 skeletal abnormalites
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1. osteogenesis imperfecta= OI- mal mineralization and you break bones easily
2. rickets- vit D deficeiney 3. Scoliosis- can be congeneital |
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whats the most common UE defect?
what age do they have the surgical release? Radial anomalies mayve be assocaited with... |
Syndactly
1-2 years. But vestigial tabs are usually removed neonatal life. abnormatalies of blood, heart, kidney |
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The most common LE abnormality-
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Congenital Hip Dysplasia DDH
Usually the left hip. |
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What is developmental dysplasia of the hip-
Risk Factors: The hip can present as... |
abnormality of the proximal femur, acetabulum or both-
- female - metatarsus adductus - torticollis - oligohydramines - first pregnancy - breech presentation subluxated, dislocatable for dislocated (usually everytime you flex your hip) |
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Clinical Manefestations of Hip dysplasia-
Name 3 positive tests for hip dysplaisa |
assymetric thigh folds
limb length descrepency limited hip Abd pain 1. positive ortloani sign (dislocation) 2. positive Barlow Test (reduction) 3. Trendelenburg gait test |
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treatment of hip dysplasia
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depends on the severity, the earlier the better
1.paliv harness for babies (98% have no future problems) 2. closed reduction and casting 3. surgery for children over 1 year old |
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Ortalani Test-
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try to abduct hip, the hear of feel a click when adducting hip.
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4% of all newborns have..
best part- talipes Equinovarus AKA |
metatarsus adductus
95% spontaneously get better clubbed foot |
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3 types of talipes equinovarus
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1. positional - treated with seriores cast
2. idiopathetic congenitial- more males, need surgery 3. teratologic- assocaited with spinda bifidia, almost always need surgery and possible muscle rebalancing procedures- because ususally end up paraplegic cuz of the spina bifida |
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Osteogensis imperfecta is a
How does it present in its most severe form? pathophysiology= treatment= |
brittal bone disease inhereited as an autosomal dominant or recessive disease.
fractures inutero rarely survive long popular in ashinazi jews problem with collagen synthesis let parents show you how to hold the baby and bisphosphate (fosomax clast inhibitors) is encouraged. |
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two types of scoleosis and describe them.
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nonstructural
- due to posture, will become structural if the underlying cuase isnt treated structural - associated with vertebral rotation, many causes but 65% is idiopathetic |
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average rate of progression of scoleosis-
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1 degree per year.
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scoleosis curves progress most rapidly during...
which ones are low risk or high risk? |
periods of maximal skeletal growth
low risk <40 high risk >60 will impinge on pulmonary function and continue to progress one degree a year- pain is a huge issue |
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osteomyelitis-
can be caused by... risk factors.... |
bone infection- most frequently between 3-12 years.
staph strep and E coli impetigo infected varacil lesions infected burns BCG immunization trauma |
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Most common site for osteomyelitis
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the knee- children will not want to move that area, whereas older kids complain of back pain
- and can affect growth if no treated |
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pauciarticular arthritis = children with this who are seronegative for ANA will...
but with ____ or _____ it can be expected to progress to ________ |
arthritis in less than 3 joints
resolve over time systemic disease or ANA JRA progress into true RA |
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osteochondrosis=
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avascular diseases of bone (no one understands the mechanism)
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legg-calve perthe
- gender- -most popular age- - natural history |
more men, more japanease
8 years old 80% self limiting 2-5 years |
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Treatement for Leggs Calve Perthe-
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- contain and maintain
- keep the hip located - keep ROM -NSAIDS, rest - modify activity, no jumping |
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what may mimic hip osteochondroses-
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slipped capital femoeral epiphyses
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osgood-schlatter
1. define- 2. age- 3. gender 4. SX 5. TX |
1. tendinitious of patellar tendon with osteochondrosis of the tibial tubrecle
2. pre and adolescents 3. more boys 4. pain, edema especfially after activities 5. restrict activities 4-8wks then gradual inc activities casting in severe cases |
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How is muscular dystrophy characterized?
is charcot marie tooth primarily a muscle problem? muscular dystrophy is a familial group of disorders that cause... |
by progressive weakness and degeneration of skeletal muscles
no degeneraton of skeletal muscle fibers |
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the most prevalent muscular disease in childhood-
how is it diagnosed |
MD
gowers maneuver (glut max) muscle biopsy genetic testing |
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most common fatal disease of young men-
weakness is _____ to ______ what is common with the LE when is the clinical onset? |
Duchenne(girls only carry it)
proximal to distal gastro pseudohypertrophy 3-5 years |
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TX for Duchannes
PT for them... |
oral steriods can help improve muscle function. Pulse the steriods to avoid side effects ( like weight gain, mood swings...)
exercise inspiratory muscles stretch heel cords keep walking ALAP ** walking increases their life extenctancy) |
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whats one way to keep duchane patients walking longer?
what is a sign that the patient will need a wheel chair? |
cut heel cords
swimming night splints (AFOs) 6months after toe walking |
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Beckers- BMB
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attenuated dystrophin levels varies
huge range life span not usually affected |
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FHS symptoms are usual benign in the teen years. What is FSH?
are their any contraindications |
fascioscapulohumeral= its progressive weakness in muscles of the face, arms, legs and around the shoulders and chest.
mild-disabling no, just dont over fatigue |
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whats the most common adult form of MD?
what do these people look like? |
myotonic MD- onset usually before 20 years old. and its multisystemic
thin faces drooping eye lids swan like neck |
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Principal complaint in myotonia congenita
most often occurs after.. its relieved by... how are these symptoms a serious problem? |
is failure of muscles to relax nomrmally after contracting- it can be pretty severe.
periods of rest, but can also be brought on by cold, fatigue or emotional stress. exercise problem in dangerous situations where they have to make quick movements |
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paramyotonia congenita-
common characteristics- episodes can be brought on by..... |
defect in na channel with suddan periodic paralysis
early childhood, generally affects the face and hands, aggravated by the cold. foods rich in K resting after excerise missing meals infection |
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spinal muscular atrophy-
name 3 types what is the major difference between these types- |
degeneration of motor neurons. most cases are thought to be inhereted.
1. infantile (severe) werdnig-hoffman disease 2. intermediate 3. mild- juvenile SMA, kugelberg-welander disease age of onset and the severity of the condition |
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Most severe form of SMA-
second worse form- |
infasntile spinal muscular atrophy- cant live beyond 18 months.
juvenile spinal muscular atrophy- usualy onset after 2 years of age. - children can walk but with great difficulty |
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Most severe form of SMA-
second worse form- |
infasntile spinal muscular atrophy- cant live beyond 18 months.
juvenile spinal muscular atrophy- usualy onset after 2 years of age. - children can walk but with great difficulty |
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Describe intermediate spinal muscular atrophy-
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- child can learn to sit unsupported which delays the diagnosis
- arm weakness isnt as bad as leg weakness - child is floppy - mental functions arent affected |
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friedreich's ataxia results in... caused by....
symptoms may first appear between any other symptoms? |
inability to coordinate muscle movements. Caused by degeneration of nerve tissue in the spinal cord and of nerves that extend to peripheral areas such as arms and legs
5-15years cant walk within 8-10 years loose sensations of touch and pressure. Remissions are uncommon, doesnt effect ,mental capacity |
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abnormatoilies with heart rythem and strength of the heart have been noted ina large percentage in.....
whats another condition that may coesist with the one above? |
frederichs ataxia patients
DM- but happens later on in the disease |
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early signs of freidrichs ataxia-
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weakness in legs
unsteadniness in standing difficulties in walking over/under extend the leg |
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process of moving air=
using oxygen= |
ventillation
respiration |
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where does asthma happen?
where does gas exchange happen? |
bronchioles- smooth muscle and are collapsable
respiratory airways |
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if P02 is 100
Hemaglobin= if P02 is 40 Heme is= If P02 is 50 Heme os= |
100%
75% 75%-100% |
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FYI
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something about caput medulla, liver destroyed , high pressure
and N2= the bends |
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Ventilation- Perfusion Matching-
so if P02 of an alveolus falls... what about the peripheral capillary bed? |
to be efficient, blood flow is directed to areas of lung that are well ventillated and away from poorly ventillated areas.
the arteriole constricts and blood in shunted to better ventillated areas. Happens oppostite - reactive hyperemia |
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venous concentration is the same as
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tissue concentration
lol just remember that |
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Normal Values
Alveolar Air (same as arterial blood) P02= PC02= Hb= Normal tissue Values P02= PC02= Hb= |
100
40 100% 40 46 60-75% |
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Air in the lungs is _____ oxygenated than air in the room
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LESS
FYI- it is easier to move C02 across a membrane than 02 |
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How many subunits of Hb does a fetus have?
What kind of shift would kidney failure cause? |
1
left shift |
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what forms the intrapleural space?
intrapleural pressure? intrapulmonary pressure? |
parietal and visceral pleura
inspiration- very subatmospheric expiration- less subatmospheric inspiration- subatmospheric exp- atmospheric |
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how can chest tubes tell you what kinda pneumothorax you have?
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high up- sucking air
high down- sucking fluid |
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Tidal Volume=
___l varies with? |
0.5L amount of air moved and out during quiet breathing
age, sex, hieght |
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IRV-
define- ____ L |
inspiratory reserve volume
- amount you can inspire ON TOP of a normal breath 2.5 L |
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ERV-
- define- ____L |
exspiratory reserve volume
- amount you can blow out after a normal exspirtaion - 1 L |
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Vital Capacity= __+__+__
TLC+ ___+___+___+___ |
IRV
ERV TV TV IRV ERV RV |
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Anatomic Dead space=
P02 and PCo2.... ____ml |
the air that remains in the lung and conducting tubes at the end of a normal expiration.
lower P02 than room air Higher PC02 than room air 150ml |
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Aveolar ventillation=
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amount of fresh air that makes it down to the alveoli.
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Interpret the Sputum
1. white and frothy 2. Bugger color ______= blood in sputum _____= sign of chronic hypoxia |
1. Virus
2. Bacterial Hemoptysis clubbed nail bed |
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what are "retractions" signs associated with dypsnea
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intercostals with no tone get sucked inwards- you can see on a baby or quadroplegic
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whats a sign that someone has orthopnea?
what does apical breathing mean? |
they sleep with a lot of pillows to alter their body positions
breathing with accessory muscles |
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Normal respiratory rate?
Total Pulomonary Ventillation Fresh air to alveoli? |
8-16
6L 350cc |
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How long do you have to live after being diagnosed with Pulomonary Fibrosis?
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about 6 months since scar tissue builds up
dec tidal vol inc rate dec fresh air to alveoli |
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What do aceinhibitors do?
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lowers BP abut after a while they cause chronic cough.
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Where does this sputum come from?
1. pink/ frothy 2. frank blood |
1. lungs
2. throat |
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two reasons foy hypercapnea
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1) hypoventillation
- easy to fix 2) metabolic |
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P02 contraindication for PT
most common reason for pulomonary edema |
less than 80
heart disease (left vebtricular failure, and hydrostatic presure decreasing) |
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Who is at risk for aspiration
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- dec cough reflex
- decreased awareness - seizures - CVA MG Guillian Barre |
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______= collapse of lung tissue
Due to... when is it most common? treatment? |
Atelectasis
Compression or Absorption comopression- fluid, tumor after surgery absoprtion- removal of air deep breathing spirometer coughing |
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Bronchiectasis=
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abnormal dialation of the bronchus- usualy after atalectasis or pulmonary efffusion gets worse- building up in airway from alveolar infection
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describe the different types of pneumothorax-
symptoms- |
open- air moves in and out with each breath
tension- air moves in and is trapped- medical emergency - lungs can collapsed sucking chest wound secondary pneumothorax- due to trauma, suddan pleura pain, tzachypnea, mild dyspnea spontaneous- ruptered blebs on the apex of lung |
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Normally, the shadow of the heart should take up ....
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1/3 total distance
if larger- cardiomeglay maybe |
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____= presence of fluid in the pleural space
Name 3 different types |
pleural effusion
1.transudative- from increased hydrostatic pressure!!! 2. exudative -WBC and plasma proteins 3. empyeme -pulmonary infections, lung abccess |
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Central line goes in what vein?
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subclavian?
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______= inflammation of the pleura
How do you know if the person has it? |
pleurisy
can hear a friction rub- and thats the only time that it hurts - almost always developes after a URI |
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Treatment for Abbcess-
How do you know if the person has it? |
chest pt
antibiotics bronchoscopy 20-50% mortaility juicy fruit smell? |
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What smells like grape gum?
Prognosis for Pulmonary Fibrosis- |
pseuddomoneious?
less than 5 years of life |
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ARDS is usuallly due to..
long term effects- classic sign- |
sepsus or transfusions due to multiple traumas.
pulomonary fibrosis hypoexemia they look like shit, need a ventillator but eventually can do fine. |
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what has the same clinical manafestations as ARDS?
whats the difference? |
postoperative respiratory failure
- i think its cuz they smoke? |
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___% of asthma developes in childhood.
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50
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treatment of Asthma
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- eliminate the cause
- treat inflammation- but steriods for too long can cause infection - relax smooth muscle |
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Chronic Bronchitis=
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Hypersecreation of mucus and cough > 3 months a year for at least 2 years
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cachetic appearance-
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wasting due to ill health
ex) emphysema |
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what used to be called "old mans friend"
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pneumonia = infection of lower respiratory tract. 6th leading cause of death
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3 ways to get pneumonia
pathology- your first line of defense= |
1. community (kids, walking, adults)
2. Hostpial (Nosocomal)- grapes, ecoli 3. Immunocompromised Individuals- from fungi, paracytes,,,, many are trasnmitted by aspiration nasopharynx than cough reflex mucous blanket |
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whats transmitted by airborn droplets?
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TB (32% of world is infected)ppd
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pps stands for
treatment fot TB |
protein purified dirivitive
- 6-9 month treatment - drug combos |
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Acute Bronchitis=
2 types |
acute inflammation of bronchi irritation casued by cough may result in progression to pneumonia
viral - most common - self limiting bacterial- propductive cough and AB Rx |
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Name 3 types of Pulmonary Vascular Disease-
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PE(occlusion of vascular bed)
Pulmonary HTN Car Pulmonale |
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Risk factors of Pulmonary Embolis
HGow does patient Physically appear? |
- venous stasis
- hypercoagulability- seen with oral contraceptives - capillary injury - 90% from DVT - leg pain streaky look homans doppler studies |
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How do you Dx PE?
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- x ray, PFT
blood gas analysis- to explain hypoxemia with hyperventillation |
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Normal Pulmonary artery pressure?
HTN? 2 types- |
15-18mmHG
5-10mmHG primary- RARE (most female, 5 year mortaility rate) and need lung transplant secondary - must treat the primary problem |
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with ____ there may not be any overt Sx until the disease is quite progressed and the right heart starts to fail
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Pulm HTN or Cor Pulmonale
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______ is autosomal recessive disease, the most common ionhererited geneitc defect in white people
effects what in body cause of death- Dx- |
Cystic Fibrosis- channel pathology of chloride
mucus (f-actin) respiratory failure sweat test FYI- 90% have pancreatic insufficiency |
