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PTA 202 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What percent of LE amputations are proceeded by a foot ulcer?

A

85%

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2
Q

54% of amputations are do to what?

A

PVD and or diabetes

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3
Q

What is the most common type of amputation?

A

Below knee (transtibial)

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4
Q

Arterial Vs. Venous

A

-Arterial: oxygenated blood flowing away from the heart to the body
-Venous: de-oxygenated blood flowing from the body to the heart

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5
Q

What is the term for when a thrombus or embolus suddenly blocks blood flow in one of your peripheral arteries?

A

Acute Arterial Occlusive Disease

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6
Q

What is the term used to describe a slow buildup of plaque in the peripheral arteries which blocks blood flow?

A

Chronic Arterial Insufficiency

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7
Q

What is the diagnosis given to those with a chronic arterial insufficiency?

A

Atherosclerosis

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8
Q

What is intermittent claudication?

A

Ischemia with activity

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9
Q

What portion of the ankle are Arterial Ulcers found and what are their characteristics?

A

-The lateral portion of the ankle, dorsum of foot, or toes
-Smooth, defined edges
-Deep
-Pain with elevation

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10
Q

Should you elevate or compress an Arterial Ulcer? Why or why not?

A

No, you want blood from the heart to get to the limb being restricted of blood flow

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11
Q

These are characteristics of which condition?
-Inflammation of the small and medium sized arteries and veins
-Occurs mainly in men who smoke
-Bilateral ischemia
-Sx are reversible with smoking cessation

A

Thromboangiitis Obliterans (Buerger’s Disease)

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12
Q

SVT vs. DVT

A

-SVT: clots in the veins near the surface of the skin and can be painful to touch
-DVT: clots in the deep veins of the body and are at risk of turning into an embolus

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13
Q

What is the Homan’s Sign used for?

A

To detect a DVT

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14
Q

Which form is a better predictor for a DVT than the Homan’s Sign test?

A

The Wells Clinical Prediction Rule for DVT

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15
Q

What portion of the ankle are Venous Stasis Ulcers found and what are their characteristics?

A

-The Medial portion of the ankle (medial malleolus)
-Irregular shaggy edges
-Shallow
-Pink or red if not infected
-Pain in dependent position
-Edema

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16
Q

Should you elevate or compress a Venous Stasis Ulcer? Why or why not?

A

Yes, because you want the buildup of blood and fluid in the LE to go back to the heart

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17
Q

Does a person’s pulse give a good indicator of a person’s arterial or venous blood flow?

A

Arterial

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18
Q

What grade is given to a normal strength pulse?

A

2+

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19
Q

What are the grades for pulse strength?

A

0= Absent, non-palpable
1+= Diminished pulse
2+= Normal pulse, easily palpable
3+= Bounding pulse, pulse is accentuated and very strong

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20
Q

A pt. with a Hx of diabetes and PVD has a diminished Dorsalis Pedis pulse on the R LE compared to the L LE. What pulse strength grade would you expect to be given to this patient?

A

1+

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21
Q

What is the Ankle Brachial Index (ABI)?

A

The ratio of systolic blood pressure in the LEs to the systolic blood pressure in the UEs

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22
Q

What is the formula used for a patient’s ABI?

A

Systolic pressure of LE/Systolic pressure of UE

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23
Q

What is considered a normal ABI reading?

A

.9 - 1.1

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24
Q

What is considered an undesireable ABI reading?

A

</= .7

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25
How do you measure for surface arterial blood flow?
Squeeze and hold a fingertip or toe for 3 seconds, let go, and see how long it takes for it to refill with blood
26
What is normal Capillary Refill Time?
2 seconds
27
What is Rubor of Dependency used to test and how do you do it?
-Used to test Arterial Insufficiency (AI) -Place pt. in supine and note color of plantar foot surface -Raise LE to 60 degrees for one minute and not any change in color -Lower LE back down to starting position, and if their was any change in color during LE elevation, note how long it takes the foot to return to normal color
28
What is considered Normal for Rubor of Dependency?
Minimal or no change in color
29
What causes a Venous Insufficiency?
The valves in the veins are lax and allowing backflow
30
How do you test for Venous Filling Time?
-Place the pt. in supine and note the superficial veins on the dorsal surface of the foot -Elevate LE to 60 degrees for 1 minute or until blood drains from veins -Lower LE to dependent position and note how long it takes the veins to refill with blood
31
What does it mean if a pt.s venous filling time is 5-15 seconds?
This is normal
32
What does it mean if a pt.s venous filling time is < 5 seconds?
This is indicative of a Venous Insufficiency
33
What does it mean if a pt.s venous filling time is >20 seconds?
This is indicative of an Arterial Insufficiency
34
What are Semmes-Weinstein Monofilaments?
Tools used to test the sensation of a diabetic foot
35
Should you apply lotion to the spaces between a diabetic pt.s toes?
No
36
What size Semmes-Weinstein monofilament should a pt. be able to feel in order to be classified as having Normal sensation?
4.17
37
What size Semmes-Weinstein monofilament should a pt. be able to feel in order to be classified as having Protective sensation?
5.07
38
What size Semmes-Weinstein monofilament should a pt. be able to feel in order to be classified as having Absent sensation?
6.10
39
Name the surgical intervention... -Removal of an emboli through an opening in an artery -Balloon catheter is inserted and when removed, pulls out the emboli
Embolectomy
40
Name the surgical intervention... -Removal of an occlusion by stripping it and the inner lining of the artery as well
Endarterectomy
41
Name the surgical intervention... -Use of the saphenous vein to bypass the obstruction -Veins are reversed so valves don't interfere -Common site for emboli
Femoral Popliteal Graft (Fem Pop)
42
What percent of people with PVD will have an amputation?
2-5%
43
What percent of people with PVD and Diabetes will have an amputation?
5-25%
44
Which muscle re-attachment procedure for amputations involves muscle to muscle?
Myoplasty
45
Which muscle re-attachment procedure for amputations involves muscle to bone?
Myodesis
46
Which muscle re-attachment procedure for amputations involves tendon to bone?
Tendonesis
47
Describe an Equal Length skin flap amputation closure
Skin is equal length on both sides of amputation and sutured together along the midline of the tip of the residual limb
48
Describe a Long Posterior skin flap amputation closure
The skin on the posterior portion of the amputation is longer than the anterior portion, resulting in a suture on the anterior portion of the residual limb and an affect known as dog ears
49
Describe a Skew Flap amputation closure
A modification made to the Long Posterior skin flap so that the flaps are skewed, therefore avoiding the dog ears affect
50
What is an Ankle Disarticulation (amputation at the ankle) also known as?
Syme's
51
What are the key LE muscle groups to focus on strengthening Pre-amputation?
Hip extensors for prosthetic control, Abd/add, knee extensors for BKA
52
Why is keeping the pt.s hip/knee in the extended position so important after a LE amputation?
-To keep from getting a flexion contracture -To be able to effectively control their prosthetic
53
What are the advantages and disadvantages of Rigid Dressing post amputation
-Good for edema and P! management -Takes skill to apply -Could end up restricting blood flow
54
What are the advantages and disadvantages of Semi-Rigid Dressing post amputation?
-Protects wound -Inexpensive -Not as effective as rigid -Could wrinkle
55
What are the advantages and disadvantages of Soft Dressing post amputation?
-Cheapest -Most Common -Hard for pt. to apply themselves -Must be reapplied frequently
56
What is essential soon after amputation in order to prepare for a prosthetic?
Shrinking of the residual limb
57
In general, how long does it take post amputation to be fitted for a prosthetic?
6-8 wks
58
What is the Number 1 Goal for post op amputees
Protect the unaffected limb
59
In what position does the leg of an AKA pt. tend to want to be in?
-Hip flexion -Lateral rotation -Abduction
60
In what position does the leg of a BKA pt. tend to want to be in?
-Hip flexion -Knee flexion
61
What position do you want to try to keep an amputation pt.s residual limb in while lying in bed?
-In the position the pt.s leg would be in while standing -Legs parallel, hips in neutral rotation, hips in neutral ab/ad
62
How would you collect data to know that your wrapping is decreasing residual limb edema?
By taking girth measurements
63
Which PT interventions can help to address phantom pain in amputees?
-IFC -US -Massage -Mirrors -Desensitization
64
What do 85% of amputations start with?
Foot ulcers
65
What is the most important piece of a prosthetic and why?
The Socket, because if it is not comfortable, the pt. won't wear it
66
What are the 2 most common types of suspension methods for prosthetics?
-Linear pin and lock -Suction/Vaccuum
67
What is the difference between Mechanical and Fluid Controlled Friction Knees in prosthetics?
-Mechanical knees have one speed for flexion and extension -Fluid controlled friction knees are able to speed up and slow down flexion and extension
68
What are the 2 most stable mechanical prosthetic knees?
-Locking knee -Weight activated safety knee
69
What are the 2 least stable mechanical prosthetic knees?
-Polycentric/ 4 bar knee -Single axis/ Outside hinges
70
How do Fluid controlled prosthetic knees control the speed of flexion/extension?
Either Pneumatic, Hydraulic, or Microprocessor systems
71
What is the Shank of a prosthetic and what are the 2 kinds?
The component used to connect the socket/knee to the foot -Endoskeletal (most common) -Exoskeletal
72
What does SACH foot stand for in terms of prosthetics?
Solid Ankle Cushion Heel
73
What are Dynamic Response Feet in terms of prosthetics, who are the for, and why?
-They are the carbon fiber feet in the shape of a boomerang or L -They are used for active patients who can put adequate energy into it -Because carbon fiber acts like a spring, so you have to put energy into it to receive energy out of it
74
Does a SACH foot have an articulated ankle joint?
No
75
What are the 2 main designs of Transtibial Sockets?
-Patella Tendon Bearing (PTB) -Total Surface Bearing (TSB)
76
What is the thought process behind a Patella Tendon Bearing socket?
It loads the pressure tolerant areas (patella tendon, medial/lateral tibia, shaft of fibula, calf) and relieves pressure from intolerant areas (end of tibia/fibula, fibular head, hamstring tendons
77
What is the thought process behind a Total Surface Bearing socket?
It creates uniform pressure for the entire limb to share equally, so that there is less pointed pressure and less perceived pressure
78
Which transtibial socket design is more commonly used now?
The Total Surface Bearing Socket
79
What are the 2 types of Transfemoral Sockets?
-Quadralateral Socket -Ischial Containment Socket
80
What is the difference between Quadralateral and Ischial Containment Sockets?
-Quadralateral sockets are square shape and maintains the ischium on top of the seat -Ischial containment sockets are oval shape and contains the ischium withing the socket
81
Is the quadralateral or ischial containment socket most common?
Ischial containment
82
Characteristics of which TT suspension method? -uses audible clicks to ensure prosthesis is on and fitting well -can have issues with rotation -in order to use, roll on liner with pin in correct orientation, use body weight to settle into distal lock
Pin and Lock suspension method
83
Characteristics of which TT suspension method? -requires discipline to ensure fitting correctly (can be harmful if used incorrectly) -works to remove air from system to eliminate movement/friction
Suction suspension method
84
Characteristics of which TT suspension method? -most secure and intimate suspension method -external pump is used to consistently draw air out of socket
Vaccuum suspension method
85
What are Medicare K levels?
A rating system used by Medicare to indicate a person's rehabilitation potential -typically determines which knee and foot are appropriate for the patient
86
What does Medicare K0 mean?
-Patient does not have ability or potential to ambulate/transfer with or without assistance -Patient does not qualify for prosthesis
87
What does Medicare K1 mean?
-Patient in Household ambulator -Only uses prosthesis to ambulate on level surfaces at a fixed cadence
88
What does Medicare K2 mean?
-Patient is a Limited Community Ambulator -Uses prosthesis to traverse low level environmental barriers such as curbs, stairs, or uneven surfaces
89
What does Medicare K3 mean?
-Patient is a Community Ambulator -Uses prosthesis to traverse most environmental barriers at a variable cadence and participates in activities beyond simple locomotion
90
What does Medicare K4 mean?
-Patient is a Child, Active Adult, or Athlete -Uses prosthesis to exceed basic ambulation skills and exhibit high impact/stress/energy levels
91
What are prosthetic socks used for?
-To maintain a constant fit while the limb changes in volume -to maintain total contact fit to prevent "bottoming out" aka distal weight bearing
92
Where are the TT socket pressure points the PTA should be aware of?
-Distal patella -Distal tibia -Fibular head -Distal medial femoral condyle
93
How and when should the prosthesis liner be cleaned?
Wash by hand on the gel side of the liner after every use?
94
How and when should prosthesis socks be cleaned?
Machine washed and hung to dry once a week

PTA 202 (4 decks)

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